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Thrombus is a major factor leading to cardiovascular diseases such as myocardial infarction and stroke. Although fibrinolytic anti-thrombotic drugs have been widely used in clinical practice, they are still limited by narrow therapeutic windows, short half-lives, susceptibility to inactivation, and abnormal bleeding caused by non-targeting. Therefore, it is crucial to effectively deliver thrombolytic agents to the site of thrombus with minimal adverse effects. Based on the long blood circulation and excellent drug-loading properties of human serum albumin (HSA), we employed genetic engineering techniques to insert a functional peptide (P-selectin binding peptide, PBP) which can target the thrombus site to the N-terminus of HSA. The fusion protein was expressed using Pichia pastoris and purified by Ni-chelating affinity chromatography. After being loaded with gold nanoparticles (Au NPs), the fusion protein formed homogeneous and stable nanoparticles (named as PBP-HSA@Au) with a diameter of 17.7 ± 1.0 nm and a zeta potential of -11.3 ± 0.2 mV. Cytotoxicity and hemolysis tests demonstrated the superb biocompatibility of PBP-HSA@Au. Platelet-targeting experiments confirmed the thrombus-targeting ability conferred by the introduction of PBP into PBP-HSA@Au. Upon near-infrared ray (NIR) irradiation, PBP-HSA@Au rapidly converted light energy into heat, thereby disrupting fibrinogen and exhibiting outstanding thrombolytic efficacy. The designed HSA fusion protein delivery system provides a precise, rapid, and drug-free treatment strategy for thrombus therapy. This system is characterized by its simple design, high biocompatibility, and strong clinical applicability. All animal experiments involved in this study were carried out under the protocols approved by the Animal Experiment Ethics Committee of Jiangnan University [JN. No20230915S0301015(423)].
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Ischemic stroke （CIS） refers to ischemic necrosis or softening of localized brain tissue caused by cerebral blood circulation disorders， ischemia and hypoxia. The incidence of CIS is the highest among cerebrovascular diseases. Reduced supply of oxygen and nutrients leads to severe loss of neurons and deficits in brain function in stroke patients. Developing treatments for ischemic stroke remains an important challenge in clinical medicine. The antioxidant N-acetylcysteine （NAC） is a precursor of glutathione， and evidence from animal models of ischemic stroke and some clinical studies suggest that NAC can effectively protect the brain from ischemic damage. In this paper， the mechanism of NAC in CIS is described from various aspects， such as anti-oxidation， inhibition of inflammation， protection of cerebral nerve and mitochondrial function， stabilization of arterial plaque and thrombolytic function， aiming to explore the relationship between NAC and CIS in depth from the basic level， and to provide a theoretical basis for the further application of NAC in the prevention and treatment of patients with ischemic stroke.
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SUMMARY BACKGROUND: Cerebrovascular accident (or stroke) and ischemic heart disease are the the major causes of death in the world. It is estimated that about 85% of strokes are ischemic in origin. Reperfusion therapy in the acute phase of ischemic stroke with a recombinant human tissue plasminogen activator is effective, but some factors influence the success of this treatment. OBJECTIVE: The aim of this study was to evaluate clinical aspects and possible determinants for reperfusion after venous thrombolysis. METHODS: This is a retrospective, cross-sectional, observational study based on a review of hospital records of inpatients diagnosed with ischemic stroke treated with intravenous thrombolysis, the main outcome being reperfusion or not. RESULTS: Data from this study revealed a predominance of females in the group of reperfused patients and males in the non-reperfused group, both maintaining moderate severity on the National Institutes of Health Stroke Scale and admission without statistical significance (p>0.18). In addition, the mean admission severity score was 13.2 for the group of reperfused patients and 14.2 for those not reperfused, and the mean ejection fraction of both groups was within normal functionality, with a mean of 0.50 for reperfused patients and 0.62 for non-reperfused patients. CONCLUSION: We found an association between successful venous chemical thrombolysis reperfusion and lower mortality in patients with acute stroke.
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Resumo A embolia pulmonar (EP) é a terceira maior causa de morte cardiovascular e a principal de morte evitável intra-hospitalar no mundo. O conceito PERT® (do inglês, pulmonary embolism response team) envolve seu diagnóstico e tratamento precoce e multidisciplinar. A trombose venosa profunda (TVP) é a sua causa inicial na maioria dos casos e é responsável por complicações como a recidiva tromboembólica, a síndrome pós-trombótica e a hipertensão pulmonar tromboembólica crônica. Uma abordagem inicial semelhante ao PERT nos casos de TVP ilíaco-femoral grave pode reduzir não apenas o risco imediato de EP e morte, mas também suas sequelas tardias. Novas técnicas percutâneas e aparatos de trombectomia mecânica para o tromboembolismo venoso (TEV) vêm demonstrando resultados clínicos encorajadores. Propomos o desenvolvimento de um conceito ampliado de resposta rápida ao TEV, que envolve não apenas a EP (PERT®) mas também os casos graves de TVP: o time de resposta rápida para o TEV (TRETEV®), ou do inglês Venous Thromboembolism Response Team (VTERT®).
Abstract Pulmonary embolism (PE) is the third leading cause of cardiovascular death and the main cause of preventable in-hospital death in the world. The PERT® (Pulmonary Embolism Response Team) concept involves multidisciplinary diagnosis and immediate treatment. Deep venous thrombosis (DVT) is the initial cause of most cases of PE and is responsible for complications such as chronic thromboembolic recurrence, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension. An aggressive approach to severe cases of iliofemoral DVT similar to the PERT® system can not only reduce the immediate risk of PE and death but can also reduce later sequelae. New percutaneous techniques and mechanical thrombectomy devices for venous thromboembolism (VTE) have shown encouraging clinical results. We propose the development of an expanded concept of rapid response to VTE, which involves not only PE (PERT®) but also severe cases of DVT: the Venous Thromboembolism Response Team (VTERT®).
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Resumen A pesar de los avances en la identificación y reco nocimiento de factores de riesgo del accidente cerebro vascular (ACV) isquémico arterial pediátrico hay escasos avances en el tratamiento hiperagudo. Los factores de riesgo más frecuentes son las arteriopatías, cardiopatías y trombofilias. La confirmación temprana con estudios neurorra diológicos es clave para considerar las terapias de re perfusión, que tienen evidencia limitada en pediatría con buen perfil de seguridad. Existe consenso en la utilización de anticoagulación en patología cardioem bólica, enfermedades protrombóticas y antiagregación en arteriopatías. El desafío futuro será lograr una coordinación entre servicios prehospitalarios y centros especializados en ACV, para mejor manejo terapéutico en etapa hiperaguda disminuyendo su morbimortalidad.
Abstract Despite advances in the identification and recogni tion of risk factors for pediatric arterial ischemic stroke, little progress has been made in hyperacute treatment. The most frequent risk factors are arteriopathies, car diopathies, and thrombophilia. Early confirmation with neuroradiological studies is key to consider reperfusion therapies, which have limited evidence in pediatrics but a good safety profile. There is consensus on the use of anticoagulation in cardio-embolic and prothrombotic diseases, and anti platelet therapy in arteriopathies. The future challenge is to improve coordination between prehospital services and specialized stroke centers to improve therapeutic management in the hyperacute stage and reduce morbidity and mortality.
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The present study assessed incidence, risk factors, in-hospital and short-term outcomes associated with no-reflow in patients undergoing percutaneous coronary intervention (PCI) in STEMI, NSTEMI, unstable angina and stable angina. Out of 449 patients, 42 (9.3%) developed no-reflow. Hypertension, dyslipidemia, obesity and smoking were significant risk factors. There was significant association of no-reflow with left main disease, multiple stents, target lesion length_x0001_ 20 mm and higher thrombus grade. Interestingly, 93 patients (23.4%) of normal flow had myocardial perfusion grade (MPG) of 0/1 with mortality in 9 (10%) patients. No-reflow is associated with poor in-hospital and short-term outcomes with higher incidence of death, cardiogenic shock, heart failure and MACE. Knowledge of risk factors of no-reflow portends a more meticulous approach to improve final outcomes. MPG could be better predictor of outcomes in these patients.
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Introdução: a terapia trombolítica é a principal medida salvadora adotada em vítimas de acidente vascular cerebral isquêmico (AVCI), adequada para a maioria delas. Entretanto, alguns pacientes não apresentam evolução clínica, piorando o prognóstico, o que constitui uma lacuna científica essencial. Objetivo: analisar os determinantes da não melhora clínica em pacientes com AVC em uso de trombolíticos rt-PA.Método: estudo observacional retrospectivo caso-controle, realizado de 2014 a 2017 por meio de busca ativa de prontuários de pacientes com AVC submetidos à terapia trombolítica em um hospital de referência no Ceará. A falência clínica foi caracterizada como ausência de redução no National Institutes of Health Stroke Scale-Score (NIHSS).Resultados: um total de 139 pacientes incluídos no estudo em uma única unidade de AVC. A média de idade foi de 66,14 anos (variando de 34 a 95). O seguimento de 24 horas foi completado em 100% dos pacientes. Resultado favorável 24 horas pós-trombólise foi observado em 113 pacientes (81,29%), e não houve melhora clínica em 26 (18,7%). A transformação hemorrágica pós-trombólise foi um forte preditor de não melhora (p=0,004), e diabetes foi o principal fator de risco modificável encontrado (p=0,040).Conclusão: diabetes e transformação hemorrágica após trombólise foram identificados como fatores de risco para não melhora clínica em pacientes com AVC agudo submetidos à terapia trombolítica.
Introduction: thrombolytic therapy is the primary saving measure adopted in ischemic cerebrovascular accident (ICVA) victims, adequate for most of them. However, some patients do not show clinical progress, worsening the prognosis, which constitutes an essential scientific gap.Objective: to analyze the determinants of clinical non-improvement in stroke patients who used rt-PA thrombolytic agentes.Methods: retrospective observational case-control study, carried out from 2014 to 2017 through an active search of medical records of CVA patients undergoing thrombolytic therapy in a reference hospital in Ceará. Clinical failure was characterized as no reduction in the National Institutes of Health Stroke Scale-Score (NIHSS).Results: a total of 139 patients enrolled in the study in a single CVA unit. The mean age was 66.14 years (range 34 to 95). The 24-hour follow-up was completed in 100% of patients. A favorable result 24 hours post-thrombolysis was observed in 113 patients (81.29%), and there was no clinical improvement in 26 (18.7%). Post-thrombolysis hemorrhagic transformation was a strong predictor of no improvement (p=0.004), and diabetes was the main modifiable risk factor found (p=0.040).Conclusion: diabetes and hemorrhagic transformation after thrombolysis were identified as risk factors for clinical non-improvement in patients with acute stroke undergoing thrombolytic therapy.
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Introducción: los síndromes coronarios agudos representan la forma aguda de la cardiopatía isquémica. Esta constituye, en Cuba, la primera causa de muerte en los últimos años. La provincia de Matanzas muestra un comportamiento similar. Objetivo: evaluar las tendencias de morbilidad y letalidad de los pacientes con síndrome coronario agudo en un período de cinco años. Materiales y métodos: se realizó un estudio descriptivo retrospectivo de corte transversal, con 734 pacientes ingresados con síndrome coronario agudo en la Unidad de Cuidados Intensivos Emergentes del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, entre enero de 2016 y diciembre de 2020. Se caracterizaron los pacientes según variables clínicas. Los datos se extrajeron de las historias clínicas. Se aplicó el test Chi cuadrado. Resultados: hubo una disminución progresiva y continua del total de pacientes con síndrome coronario agudo en los cinco años estudiados. Sobresalió el sexo masculino, con un 53,67 % (p < 0,02). El grupo etario más afectado fue el de 60 a 69 años. El síndrome coronario agudo sin elevación del segmento ST prevaleció en cuatro de los años analizados. Preponderó la instauración del tratamiento trombolítico en el 78,75 % de los pacientes con síndrome coronario agudo con elevación del ST. El total de fallecidos decreció en el período estudiado. Se demostró la importancia de la aplicación de la trombolisis. Conclusiones: en el quinquenio estudiado, disminuyó gradualmente el total de pacientes con diagnóstico de síndrome coronario agudo, y la letalidad por esta causa, en la Unidad de Cuidados Intensivos Emergentes del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas.
Introduction: acute coronary syndromes represent the acute form of ischemic heart disease. In Cuba, it is the first cause of death in recent years. The province of Matanzas shows similar behavior. Objective: to evaluate morbidity and lethality tendencies of the patients with acute coronary syndrome in a period of five years. Materials and methods: a descriptive, retrospective, cross-sectional study was carried out with 734 patients admitted with acute coronary syndrome in the Emergency Intensive Care Unit of the Clinical Surgical University Hospital Comandante Faustino Perez, of Matanzas, between January 2016 and December 2020. The patients were characterized according to clinical variables. The data were extracted from clinical records. The Chi-square test was applied. Results: there was a progressive and continuous decrease of the total of patients with acute coronary syndrome in the studied five years. Male gender stood up with 53.67% (p < 0, 02). The most affected age group was the 60-69 years one. The acute coronary syndrome without ST segment elevation prevailed in four of the analyzed years. The establishment of the thrombolytic treatment prevailed in 78.75% of the patients with ST segment elevated acute coronary syndrome. The total of deaths decreased in the studied period. The importance of thrombolysis application was demonstrated. Conclusions: the total of patients with diagnosis of acute coronary syndrome and lethality due to this cause gradually decreased in the studied five-year period in the Emergency Intensive Care Unit of the Clinical Surgical Hospital Comandante Faustino Perez Hernandez, of Matanzas.
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Objective To compare the clinical effects of three treatment methods including systemic thrombolysis(ST),catheter-directed thrombolysis(CDT),and AngioJet percutaneous mechanical thrombectomy(PMT)in acute lower extremity deep venous thrombosis(LEDVT). Methods The data of 82 patients diagnosed with LEDVT in the Department of Vascular and Gland Surgery of the First Affiliated Hospital of Hebei North University from January 2017 to December 2020 were collected.The patients were assigned into a ST group(n=50),a CDT group(n=16),and a PMT group(n=16)according to different treatment methods.The efficacy and safety were compared among the three groups. Results Compared with that before treatment,the circumferential diameter difference of both lower limbs on days 1,2,and 3 of treatment in the ST,CDT,and PMT groups reduced(all P<0.001).The PMT group showed smaller circumferential diameter difference of lower limbs on days 1,2,and 3 of treatment than the ST group(all P<0.001)and smaller circumferential diameter difference of the lower patellar margin on day 1 of treatment than the CDT group(P<0.001).The PMT group showed higher diminution rate for swelling of the affected limb at the upper and lower edges of the patella than the ST group(P<0.001)and higher diminution rate for swelling at the upper edge of the patella than the CDT group(P=0.026).The incidence of complications after treatment showed no significant differences among the three groups(all P>0.05).The median of hospital stay in the PMT group was shorter than that in the ST and CDT groups(P=0.002,P=0.001).The PMT group had higher thrombus clearance rate than the ST group(P=0.002)and no significant difference in the thrombus clearance rate from the CDT group(P=0.361).The vascular recanalization rates in the PMT(all P<0.001)and CDT(P<0.001,P=0.002,P=0.009)groups 3,6,and 12 months after treatment were higher than those in ST group,and there were no significant differences between PMT and CDT groups(P=0.341,P=0.210,P=0.341). Conclusions ST,CDT,and PMT demonstrated significant efficacy in the treatment of LEDVT,and PMT was superior to ST and CDT in terms of circumferential diameter difference of the lower limbs,diminution rate for swelling of the affected limb,thrombus clearance rate,length of hospital stay,and long-term vascular recanalization.There was no obvious difference in safety among the three therapies.
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Humans , Thrombolytic Therapy/methods , Fibrinolytic Agents/therapeutic use , Treatment Outcome , Thrombectomy/methods , Venous Thrombosis/drug therapy , Lower Extremity/blood supply , Catheters , Retrospective StudiesABSTRACT
Objective:To compare the effectiveness and safety of mechanical thrombus aspiration combined with superior mesenteric artery transcatheter thrombolysis with those of simple superior mesenteric artery transcatheter thrombolysis in the treatment of portal vein-superior mesenteric vein thrombosis.Methods:A retrospective case-control study was used to analyze the clinical data of 27 patients with portal vein thrombosis treated by interventional therapy in Beijing Friendship Hospital Affiliated to Capital Medical University from February 2020 to October 2022. According to different interventional procedures, they were divided into two groups: 13 cases were treated with mechanical thrombus aspiration combined with superior mesenteric artery catheterization thrombolysis (combined treatment group), and 14 cases were treated with superior mesenteric artery catheterization thrombolysis alone (catheterization thrombolysis group). The postoperative and preoperative portal vein thrombus grade, catheterization thrombolysis time, parenteral nutrition time and operation-related complications were observed and compared between the two methods, and the incidence of long-term intestinal necrosis was compared after postoperative follow-up. Measurement data of normal distribution were expressed as mean±standard deviation( ± s), t-test was used for comparison between groups. Counting data were expressed as cases and percentage(%), and comparison between groups was used Chi-square test or Fisher exact probability method. Results:There was significant difference in the grade of portal vein thrombosis between the combined treatment group and the catheterization thrombolysis group( P<0.05). The thrombolytic time of catheterization in the two groups was (2.38±0.74) d and (4.79±1.15) d, respectively, and the time of parenteral nutrition was (4.08±2.87) d and (8.50±3.16) d, respectively. The difference was statistically significant ( P<0.05). There was no significant difference in operation-related complications between the two groups ( P>0.05). There were no severe injury of liver and kidney function in both groups. One patient in each group underwent long-term enterectomy. Conclusions:Mechanical thrombus aspiration combined with superior mesenteric artery thrombolysis is safe and effective in the treatment of portal vein thrombosis. Compared with simple superior mesenteric artery thrombolysis, mechanical thrombus aspiration combined with superior mesenteric artery thrombolysis can increase the rate of thrombus clearance and reduce the time of thrombolysis and parenteral nutrition support.
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OBJECTIVE@#To observe the effects of acupuncture on neurologic function and serum inflammatory factors in patients after thrombolysis in acute ischemic stroke (AIS).@*METHODS@#A total of 102 AIS patients with onset to treatment time (OTT) ≤3 h were randomly divided into an observation group and a control group, 51 cases each group. In the control group, thrombolysis and conventional medical treatment were applied. On the basis of the treatment as the control group, acupuncture at Shuigou (GV 26), Zhongwan (CV 12), Qihai (CV 6), Neiguan (PC 6), etc. was applied in the observation group, 30 min each time, once a day. Both groups were treated for 2 weeks. Before and after treatment, the scores of National Institutes of Health stroke scale (NIHSS), modified Rankin scale (mRS), modified Barthel index (MBI) and serum level of homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP) were compared, and the clinical efficacy was evaluated in the two groups.@*RESULTS@#After treatment, the scores of NIHSS, mRS and serum level of Hcy, hs-CRP were decreased compared with those before treatment (P<0.05), while the MBI scores were increased (P<0.05) in the two groups. The scores of NIHSS, mRS and serum level of Hcy, hs-CRP in the observation group were lower than those in the control group (P<0.05, P<0.01), the MBI score in the observation group was higher than that in the control group (P<0.01). The total effective rate was 88.2% (45/51) in the observation group, which was superior to 70.6% (36/51) in the control group (P<0.05).@*CONCLUSION@#Acupuncture could promote the recovery of neurologic function in patients after thrombolysis in AIS, improve the ability of daily living, which may be related to reducing the level of inflammatory factors, thus inhibiting inflammatory response and improving cerebral ischemia reperfusion injury.
Subject(s)
Humans , United States , Ischemic Stroke , C-Reactive Protein , Acupuncture Therapy , Inflammation , Homocysteine , Hypersensitivity , Thrombolytic TherapyABSTRACT
Central retinal artery occlusion(CRAO), also known as eye stroke, always results in acute and painless visual loss. At present, conservative treatments, such as eye massage, lowering intraocular pressure and vasodilators have little effect on reducing visual loss. Intra-arterial thrombolysis(IAT)has significantly improved prognosis in patients with acute ischemic stroke, thus IAT has been gradually applied in the treatment of CRAO. IAT injects fibrinolytic drugs directly into the ophthalmic artery by a microcatheter, and dissolves the emboli that block the central retinal artery to restore the blood flow of the retina. Theoretically, IAT may be effective for CRAO as what has been found for stroke, but existing clinical studies exhibited inconsistent results. This paper summarizes the feasibility, efficacy, and safety of IAT treatment in CRAO. It will also analyze related factors that affect the prognosis, putting forward potential development directions and providing insights for the further clinical application of IAT.
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Objectives@#To determine the outcomes for patients with acute stroke improve with early intervention in a series of the first 50 patients with acute ischemic stroke who were thrombolysed at our center. @*Methods@#National Institutes of Health Stroke Scale (NIHSS) scores were recorded by NIHSS-certified nurses-on-duty in their appropriate monitoring sheets in the chart, which was double-checked by the neurology consultant co-author on duty. Source chart entries were cross-checked with logs from the CT scan, pharmacy, and other department records before being collated by the primary author. Means and averages were used to describe the patients’ data.@*Results@#We included the first 50 patients with acute ischemic stroke, eligible for and who consented for thrombolysis. The patients had an average age of 61 years (range: 29 to 87); 32 (64%) were ≥ 60 years; 16 (32%) were male. Male gender (24/50), age ≥ 60 years old (32/50), hypertension (30/50), heart disease (6/30), smoking (7/30), and ethanol intake (9/30) were the most common risk factors. Thirty-five (70%) suffered a moderate stroke. The mean NIHSS of the 50 patients was 12.6 (range: 2 to 28). All but one received intravenous recombinant tissue plasminogen activator (IV rTPA) within 4.5 hours of onset, at a dose of 0.6 to 0.9 mg/kg. Symptomatic hemorrhagic transformation occurred in one (2%); asymptomatic hemorrhagic transformation was seen in three (6%). Fifteen of the 50 (30%) were NIHSS = 0 on discharge; another 18 (36%) showed clinical improvement compared to their status upon admission. Three patients (6%) were mRS = 0; and 30 (60%) were at least ambulatory (mRS ≤ 3) on discharge. Four patients (8%) died, one (2%) from fatal hemorrhagic transformation. Ten patients (20%) developed nosocomial pneumonia; two (4%) had catheter-related urinary tract infections More than half (52%) did not develop any in-hospital complications. The patients were admitted for a mean of 6.6 days (range < 24 hours to 20 days). The average gross bill was ₱56,041.34 (range: ₱8,729.83 to ₱182,054.08); P32,194 was the average amount our Center shouldered per patient (range: zero to ₱154,272.88); almost all were Charity Service patients who used the ₱19,600 Philippine Health Insurance Corporation case rate and the 20% senior citizen discount to help defray the costs of their hospitalization.@*Conclusion@#Stroke thrombolysis can be done in a rural tertiary hospital safely and effectively if with strong government, administration, health care workers, and community support.
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Objective:To explore the short-term efficacy and safety of intra-arterial thrombolysis (IAT) in the treatment of retinal artery occlusion (RAO) with the assistance of the rescue green channel in the eye stroke center.Methods:A prospective, interventional, single-center study. Thirty-eight eyes from 38 RAO patients who received IAT treatment in Guangdong Provincial People’s Hospital were enrolled. All the patients were rescued via the green channel in our eye stroke center. Data from comprehensive ocular examinations including best-corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) were collected. BCVA was measured with Snellen chart and converted to the logarithmic minimum angle of resolution (logMAR) unit for statistical analysis. RTVue XR OCTA was used to measure vascular densities (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillary (RPC), and central retinal thickness (CRT). All RAO eyes attempted IAT treatment and 34 eyes were successful. Four eyes failed to complete IAT because of the occlusion of internal or common carotid arteries on the same side with the RAO eyes. Ocular examinations in post-operative 1-3 days were performed with the same devices and methods as those before surgery. Parameters measured before and after surgery include BCVA, VD of SCP, DCP, RPC, and CRT. Data of the green channel collected include the time intervals from onset of RAO to first presentation in local hospitals, and from onset of RAO to our eye stroke center. Comparisons of VD and CRT between the RAO eyes and contralateral healthy eyes were performed with independent samples Mann-Whitney U test; comparisons of VD and CRT in RAO eyes before and after IAT surgery were performed with paired samples Wilcoxon Rank Sum test. Results:Among the 34 RAO patients who had successful IAT surgery, 18 (52.9%, 18/34) were males and 16 (47.1%, 16/34) were females; the mean age was (51.0±12.9) years old. There were 30 and 4 eyes diagnosed as central RAO and branch RAO respectively. The logMAR BCVA before and after IAT surgery was 2.52±0.61 and 2.18±0.85 respectively, and the difference was statistically significant ( Z=-3.453, P=0.002). Before surgery, VD of SCP, DCP and RPC were significantly decreased and CRT was significantly increased in the affected eye compared with the contralateral healthy eyes, with the statistical significance ( P<0.001). Compared with those before surgery, the VD of SCP and DCP were significantly improved after surgery ( Z=-2.523, -2.427; P=0.010, 0.014), while there was no difference in VD of RPC and CRT ( Z=-1.448, -1.454; P=0.150, 0.159). The time interval between onset of RAO and first visit to the hospital was (6.56±6.73) hours; the time interval between onset of RAO and the arrival at our hospital was (24.11±19.90) hours. No cerebral stroke was observed in the early postoperative period and no cerebrocardiovascular events were observed later. he time interval between onset of RAO and the arrival at our hospital was (24.11±19.90) hours. No cerebral stroke was observed in the early postoperative period and no cerebrocardiovascular events were observed later. Conclusions:The short-term efficacy and safety of IAT in the treatment of RAO were satisfactory. The rescue time window might be prolonged.
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Objective:To evaluate percutaneous mechanical thrombectomy (PMT) using Aspirex device for treating acute iliofemoral deep vein thrombosis (IFDVT).Methods:The clinical and follow-up data of 68 patients with IFDVT at our institution from Jan 2019 to Jun 2021 was retrospectively analyzed.Results:Twenty-six patients who had received PMT combined with auxiliary catheter directed thrombolysis (CDT) were included into group A, and 42 patients received CDT alone were into group B.The final thrombus clearance rates were more than 50%, and the clinical efficacy of thrombolysis was achieved. Group A associated a significant reduction in lysis duration and UK dosage and hospital days and degree of detumescence after 24 h compared with group B,and all aforementioned differences were statistically significant. Hospitalization costs in group A were more than group B. At one year follow-up, there were no significant differences between the two groups in the cumulative prevalence post-thrombotic syndrome (PTS) and the Villalta score and primary patency (92.0% vs. 90.0% , χ2=0.059, P=0.807). Conclusions:The application of PMT using the Aspirex device for acute IFDVT was safe and effective, which could accelerate the clearance of thrombus, and reduce UK dosage, lysis duration, hospital days. However, it increased the hospitalization costs.
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Objective:To investigate the efficacy and safety of thrombolytic therapy with intravenous alteplase(rt-PA)for elderly acute ischemic stroke patients on maintenance hemodialysis.Methods:In this retrospective study, data of 165 elderly patients with acute cerebral infarction on maintenance dialysis, aged 65-85, treated at the Stroke Center of the Fourth Central Hospital Affiliated to Nankai University between May 2018 and March 2021, were collected.Based on whether intravenous thrombolysis with alteplase(rt-PA)was used and differences in thrombolytic schemes, patients were divided into a conservative treatment group( n=58, receiving only standardized secondary stroke prevention), a low-dose rt-PA group( n=57, receiving rt-PA intravenous thrombolysis, 0.6 mg/kg)and a standard-dose rt-PA group( n=50, receiving rt-PA intravenous thrombolysis, 0.9 mg/kg). The safety and efficacy of rt-PA treatment were assessed. Results:The rate of effectiveness at 24 h and the rate of good prognosis at 7 d were 64.9%(37/57)and 70.2%(40/57)for the low-dose rt-PA group and 68.0%(34/50)and 74.0%(37/50)for the standard dose group, respectively.There was no significant difference between the two groups( χ2=0.417, P=0.518; χ2=0.636, P=0.425), but these rates were better than 29.3%(17/58)and 41.4%(24/58)for the conservative treatment group( χ2=10.583、16.714, P<0.001). The good prognosis rate at 90 days were 73.7%(42/57), 78.0%(39/50)and 69.0%(40/58)for the three groups, respectively, with no significant difference( χ2=1.126, P=0.569), but the fatality rate for the low-dose rt-PA group was 7.0%(4/57), lower than 18.0%(9/50)( χ2=5.420, P=0.020)for the standard dose rt-PA group and 20.0%(8/58)for the conservative treatment group( χ2=5.048, P=0.025). The incidence of intracranial hemorrhage was 8.8%(5/57)for the low-dose rt-PA group, lower than 24.0%(12/50)for the standard-dose rt-PA group( P=0.032). The incidence of extracranial complications was 15.8%(9/57)for the low-dose rt-PA group, lower than 36.0%(18/50)for the standard-dose group( P=0.017). Conclusions:For elderly patients with acute cerebral infarction on maintenance hemodialysis, intravenous thrombolytic therapy with low dose rt-PA should be considered with caution.
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Objective:To establish a modified controlled abciximab and device investigation to lower late angioplasty complication (CADILLAC) score, and to compare the predictive value of modified CADILLAC score, the global registry of acute coronary event (GRACE) score and the thrombolysis in myocardial infarction (TIMI) score in predicting the risk of short-term death after percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI).Methods:A retrospective study was conducted. The clinical data of 169 STEMI patients under going PCI admitted to the department of cardiology of Guizhou Provincial People's Hospital from September 2019 to December 2020 through emergency chest pain fast track were enrolled. A multivariate Logistic regression analysis was used to screen the factors closely related to the mortality risk within 30 days of STEMI, and a modified CADILLAC scoring system was established by referring to CADILLAC scoring settings. The score of modified CADILLAC, GRACE and TIMI scores of patients were calculated after admission, and the number of deaths due to cardiovascular disease (CVD) within 30 days after onset was recorded. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of three scoring systems on the risk of death within 30 days after PCI in patients with STEMI.Results:In 169 STEMI patients, 16 patients died of CVD within 30 days after PCI, and the actual case mortality was 9.47%. Multivariate Logistic regression analysis showed that age > 75 years old, cardiac function Killip ≥ Grade Ⅲ, ventricular arrhythmia, ST segment elevation ≥ 0.2 mV, cardiac troponin I (cTnI) increase, systolic blood pressure (SBP) < 90 mmHg (1 mmHg ≈ 0.133 kPa) were all independent predictors of death after PCI in STEMI patients. The improved CADILLAC scoring system was constructed based on the above predictive factors combined with left ventricular ejection fraction (LVEF) less than 0.40. The GRACE, TIMI and modified CADILLAC scores of dead patients were significantly higher than those of survival patients (GRACE score: 197.60±31.83 vs. 149.81±36.72, TIMI score: 11.21±2.13 vs. 7.27±1.97, modified CADILLAC score: 12.60±2.52 vs. 6.96±2.17, all P < 0.05). The higher the risk stratification of the three scores, the higher the mortality of patients with CVD within 30 days after PCI [the mortality of patients with low, medium and high risk in GRACE score were 2.41% (2/83), 9.61% (5/52) and 26.47% (9/34); the mortality of patients with low, medium and high risk in TIMI score were 3.12% (3/96), 12.82% (5/39) and 23.53% (8/34); and the mortality of patients with low, medium and high risk in modified CADILLAC score were 3.19% (3/94), 7.69% (4/52) and 39.13% (9/23), respectively, all P < 0.01]. The area under the ROC curve (AUC) of the GRACE, TIMI and the modified CADILLAC scores predicting the risk of death 30 days after PCI in STEMI patients were 0.855 [95% confidence interval (95% CI) was 0.702-0.923], 0.725 (95% CI was 0.666-0.812) and 0.882 (95% CI was 0.732-0.936), respectively, all P = 0.000; the sensitivity of its prediction accuracy were 81.59%, 78.65% and 89.26%, and the specificity were 78.62%, 57.12% and 75.54%, respectively. Conclusions:The GRACE and the modified CADILLAC scores have predictive value for the short-term mortality risk of STEMI patients after PCI, and the modified CADILLAC score is more accurate. But the TIMI score has a poor predictive effect on the short-term mortality risk of STEMI patients after PCI.
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Objective:To analyze the effects of butylphthalide combined with alteplase on acute ischemic stroke.Methods:A total of 176 patients with acute ischemic stroke who received treatment at The Second People's Hospital of Liaocheng from November 2020 to October 2021 were prospectively included in this study. They were divided into control and combined treatment groups ( n = 88/group) according to hospital registraction number. The control group was given intravenous thrombolysis with alteplase. The combined treatment group was intravenously administered alteplase for 6 hours followed by butylphthalide sodium chloride injection. The two groups were treated for 2 consecutive weeks. The National Institutes of Health Stroke Scale score, clinical efficacy, interleukin-6, tumor necrosis factor-α, and high-sensitivity C-reactive protein levels as well as the incidence of adverse drug reactions were compared between the two groups. Results:After thrombolysis, the National Institutes of Health Stroke Scale score, interleukin-6, tumor necrosis factor-α, and high-sensitivity C-reactive protein levels in the combined treatment group were (4.23 ± 1.75) points, (6.42 ± 2.05) ng/L, (13.42 ± 3.59) ng/L, and (3.17 ± 0.94) mg/L, respectively, which were significantly lower than (7.28 ± 1.93) points, (9.58 ± 2.79) ng/L, (22.28 ± 3.73) ng/L, and (5.23 ± 1.25) mg/L, respectively in the control group ( t = 10.98, 20.29, 16.06, 12.36, all P < 0.001). The total response rate in the combined treatment group was significantly higher than that in the control group [94.32% (83/88) vs. 80.68% (71/88), χ2 = 7.48, P < 0.05]. There was no significant difference in the incidence of adverse drug reactions between the combined treatment and control groups [6.82% (6/88) vs. 11.36% (10/88), χ2 = 0.01, P > 0.05]. Conclusion:Butylphthalide combined with alteplase for the early treatment of acute ischemic stroke can increase therapeutic efficacy, improve neurological function, and reduce inflammatory responses. The combined therapy has a positive clinical value in the early treatment of acute ischemic stroke.
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Objective:To investigate the clinical efficacy of intravenous thrombolysis with a recombinant tissue plasminogen activator at different time windows on acute ischemic stroke in patients.Methods:A total of 172 patients with acute ischemic stroke who received treatment in Lishui Municipal Central Hospital from January 2019 to December 2021 were included in this study. They were divided into observation (onset to admission < 3 hours, n = 86) and control (onset to admission = 3-4.5 hours, n = 86) groups according to the time from onset to admission. Clinical efficacy, coagulation indexes, the National Institutes of Health Stroke Scale score, and the modified Rankin Scale score were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group [89.54% (77/86) vs. 75.58% (65/86), χ2 = 4.89, P < 0.05]. After treatment, fibrinogen, low whole blood viscosity, and plasma viscosity in the observation group were (2.55 ± 0.62) g/L, (9.68 ± 1.37) mPa·s, (1.45 ± 0.17) mPa·s, respectively, which were significantly higher than (1.53 ± 0.58) g/L, (9.19 ± 1.46) mPa·s, (1.32 ± 0.15) mPa·s in the control group ( t = -11.14, -2.27, -5.32, all P < 0.05). Antithrombin III level in the observation group was significantly lower than that in the control group [(91.65 ± 7.23)% vs. (97.74 ± 6.82)%, t = 5.68, P < 0.05]. At 2 hours, 1 day, and 2 weeks after thrombolysis, the National Institutes of Health Stroke Scale scores in the observation group were (2.49 ± 0.31) points, (1.98 ± 0.24) points, (1.79 ± 0.05) points, which were significantly lower than (3.32 ± 1.08) points, (2.69 ± 0.35) points, (2.18 ± 0.21) points in the control group ( t = 6.85, 15.52, 16.75, all P < 0.001). After treatment, the modified Rankin Scale score in the observation group was significantly lower than that in the control group [(2.01 ± 0.79) points vs. (2.88 ± 0.64) points, t = 7.94, P < 0.001]. Conclusion:Intravenous thrombolysis with a recombinant tissue plasminogen activator within 4.5 hours after onset exhibits good therapeutic efficacy in patients with acute ischemic stroke. Earlier thrombolysis leads to better therapeutic efficacy and prognosis.
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Objective:To explore the mediating effects of disease perception on disease uncertainty and health behaviors among thrombolysis therapy in patients with acute ischemic stroke, to provide a theoretical basis for improving patient health behavior.Methods:By cross-sectional survey methods, from June 2021 to June 2022, a total of 123 thrombolysis therapy in patients with acute ischemic stroke were investigated by general information, Mishel Uncertainty in Illness Scale, Health Behavior Scale for Stroke Patients and Revised Illness Perception Questionnaire by convenience sampling method. The mediating effect of disease perception between disease uncertainty and health behavior was verified by structural equation model.Results:The scores of disease uncertainty, health behaviors and disease perception were (52.21 ± 7.67), (63.77 ± 9.40), (127.70 ± 26.19) points in patients with acute ischemic stroke. Health behaviors and each dimension including exercise, medication, instruction, nutrition, responsibility, tobacco and alcohol were negatively correlation between disease uncertainty ( r values were -0.762 to -0.411, all P<0.01), and positively correlation between disease perception ( r values were 0.689 to 0.912, all P<0.01). Disease uncertainty was a significantly negative predictor for health behaviors ( β= -0.71, P<0.01); disease perception was also a significantly negative predictor for disease perception ( β = -0.85, P<0.01). Disease uncertainty had a significantly indirect effect on the health behaviors for thrombolysis therapy in patients with acute ischemic stroke through disease perception, which showed the mediating effect of health behaviors accounts for 15.2% of total effect. Conclusions:Disease perception play a mediating role in the relationship between disease uncertainty and health behaviors among thrombolysis therapy in patients with acute ischemic stroke.