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The acute ischemic stroke has become the first major disability and death disease in China.With the release of the results of five trials represented by the Dutch multicenter randomized clinical trials of intravascular treatment of acute ischemic stroke, mechanical thrombectomy has become the main means to treat the acute ischemic stroke caused by the occlusion of large intracranial vessels, ushering in a new era of mechanical thrombectomy for acute cerebral infarction.At present, the main devices of mechanical thrombectomy are Merci thrombectomy device, penumbra thrombectomy device, solitairetm fr stent, revive se stent, trevo stent and aperio ® stent.According to the location and conditions of vascular embolism, different types of thrombectomy devices should be selected, and different thrombectomy technologies, such as adapt technology, solumbra Technology, advance technology, save technology, swim technology, etc So as to improve the recanalization rate and reduce complications.
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Objective:To explore the efficacy and safety of the remedial stent implantation after mechanical thrombectomy for acute cerebral infarction.Methods:From October 2014 to December 2018, the clinical data of 16 patients with acute cerebral infarction who could not maintain forward blood flow after mechanical thrombectomy in 985 Hospital of joint service support force of PLA were analyzed retrospectively.To analyze the score of National Institutes of Health Stroke Scale (NIHSS), degree of vascular recanalization after operation thrombolysis incerebral infarction(TICI) classificatio, mechanical thrombolytic number, postoperative vascular reocclusion rate, incidence of intracranial hemorrhage, NIHSS score 1 week later, good clinical result after 90 days(improved Rankin scale, mRs= 0-2) and other indicators.Results:After mechanical embolectomy, 16 stents were implanted (15 of them were Solitaire stents, 1 of them was Apollo stents), 12 patients with TICI=3, and 4 patients with TICI=2b.The average number of times of mechanical thrombectomy was(3.25±1.09). Balloon expansion was performed before stent placement in 7 patients with limited stenosis.The time from the onset to the reperfusion was(10.96 ± 3.24) hours. Computed tomography angiography(CTA) was reexamined 24 hours after operation, showing vascular of 3 cases were reocclusion and 3 cases occured intracranial hemorrhage(all less than 10 ml). In 2 cases of decompressive osteotomy, NIHSS score was improved from preoperative (24.25±4.58) points to postoperative (7.44±5.09) points.After 90 days, 10 patients had a good prognosis (mRs ≤ 2) and 1 patient died (pulmonary infection).Conclusion:After mechanical thrombectomy of acute cerebral infarction, if there is severe stenosis or forward blood flow can not be maintained, use the Solitaire stent or other stent to remedy the placement, with fewer complications and better clinical effect.
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The acute ischemic stroke has become the first major disability and death disease in China.With the release of the results of five trials represented by the Dutch multicenter randomized clinical trials of intravascular treatment of acute ischemic stroke, mechanical thrombectomy has become the main means to treat the acute ischemic stroke caused by the occlusion of large intracranial vessels, ushering in a new era of mechanical thrombectomy for acute cerebral infarction.At present, the main devices of mechanical thrombectomy are Merci thrombectomy device, penumbra thrombectomy device, solitairetm fr stent, revive se stent, trevo stent and aperio ? stent.According to the location and conditions of vascular embolism, different types of thrombectomy devices should be selected, and different thrombectomy technologies, such as adapt technology, solumbra Technology, advance technology, save technology, swim technology, etc So as to improve the recanalization rate and reduce complications.
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Objective To analyze the clinical efficacy of Yanshu compound sophora flavescens injection (Yanshu injection) combined with paclitaxel and cisplatin (TP) regimen in the treatment of advanced non-small cell lung cancer (NSCLC). Methods One hundred and sixty-two patients with NSCLC admitted to the Department of Oncology of Danyang Hospital of Traditional Chinese Medicine from May 2014 to June 2018 were enrolled, all of their definite diagnosis was based on pathological or cytological examinations, and they were divided into two groups by the administration type, 81 cases in each group. The western medicine treatment group (western group) was treated with TP regimen alone, 3 weeks constituting 1 therapeutic course, and 3 consecutive courses were treated; based on the treatment of western drug TP regimen, the integrated traditional Chinese and western medicine treatment group (combined group) was additionally and simultaneously given Yanshu injection for consecutive 2 weeks. After treatment, the clinical efficacy and incidence of adverse reactions of the two groups were observed. Results The total effective rate in the combined group was significantly higher than that in western group [60.49% (49/81) vs. 40.74% (33/81), P <0.05]; the incidences of adverse events: alopecia, thrombocytopenia, neurotoxicity, leukopenia, nausea and vomiting, and gastrointestinal reaction in the combined group were obviously lower than those in western group [alopecia: 24.69% (20/81) vs. 60.49% (49/81), thrombocytopenia: 23.45% (19/81) vs. 40.74% (33/81), neurotoxicity: 14.81% (12/81) vs. 34.57% (28/81), leukopenia: 17.28% (14/81) vs. 62.96% (51/81), nausea and vomiting: 14.81% (12/81) vs. 60.49% (49/81), gastrointestinal reaction: 27.16% (22/81) vs. 62.96% (51/81), all P < 0.05]. Conclusion Yanshu injection combined with TP regimen is obviously effective in the treatment of advanced NSCLC, thus it is worthy to be applied clinically.
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Objective To understand the present situation and existing problems of the pharmaceutical care of Nutrition Support Pharmacists (NSP) in China and provide reference for pharmaceutical care of NSP. Method Literatures about pharmaceutical care from NSP were retrieved in domestic medical journals from January 2011 to January 2017, and totally 24 articles were analyzed and discussed. Result There were still many problems in NSP, such as the use of Nutritional Risk Screening, and the ratio of glucose/lipid ratio, ratio of non-protein energy to ni-trogen ratio, the lack or excess of vitamin and trace elements and the use of insulin and propylene ammonia acyl glu-tamine in total parenteral nutrition prescription, TPN osmotic pressure and drip time, and the application of glucose and fat milk energy density. Conclusion The pharmaceutical care of NSP starts relatively late, there are still many problems, and the capacity and theoretical level of NSP need to be improved.
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Objective To evaluate the safety and effectiveness of mechanical thrombectomy with Solitaire stent in intracerebral relatively small artery occlusions,such as the anterior cerebral artery,the posterior cerebral artery, the middle cerebral artery M2-M3. Methods The clinical data of thirteen cases of acute cerebral infarction caused by occlusion of relatively small vessels ( anterior cerebral artery, posterior cerebral artery, middle cerebral artery M2-M3 ) caused by intravenous thrombolytic time window with relative small vascular occlusion in our hospital were reviewed and analyzed. The NIHSS score, occlusion of vascular recanalization,surgical complications,and clinical prognosis (3 months mRs) were analyzed before and after discharge,including 6 cases of M2-M3 occlusion in the middle cerebral artery,3 cases of anterior cerebral artery occlusion and 4 cases of posterior cerebral artery occlusion. Results In 13 cases, the time window of thrombectomy was 3. 5～7. 0 h,the time from onset to reflow was (4. 53±3. 21) h,and 13 cases of blood vessels were completely repassed,of which 11 cases were grade 3 TICI,and 2 cases of 2b grade in TICI classification. 2 cases of postoperative small lateral fissure and subarachnoid hemorrhage. The score of NIHSS was reduced from (19. 53±1. 62)points to (3. 15±0. 41)points at 2 weeks. The difference was statistically significant (t=1. 763, P<0. 01);the mRs scores of 90d were 0 points 7 cases(53. 85％),1 points 3 cases(23. 08％),2 points cases ( 23. 08％) ,death 0 case. Conclusion The patients with acute cerebral infarction caused by relatively small vascular occlusion, such as the anterior cerebral artery, the posterior cerebral artery and the middle cerebral artery ( M2-M3) are treated with stent embolectomy in the time window. The rate of vascular repassage is high and the complications are low, and the patient′s disability rate can be significantly reduced and the clinical prognosis is better.
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Objective To study the expression of interleukin-6 (IL-6) and hepcidin in patients with diffuse large B-cell lymphoma (DLBCL) and their significance in anemia. Methods 45 DLBCL patients with or without anemia were analyzed. Peripheral blood samples were collected during diagnosis, and the concentrations of IL-6, hepcidin, serum ferritin and hemoglobin (Hb) were measured. 24 healthy volunteers were collected as controls. Results The levels of plasma hepcidin and IL-6 in patients with DLBCL were (347±171)μg/L and 0.27 ng/L (0-9.61 ng/L), respectively, and compared with those [(175 ± 92)μg/L] and 0 ng/L in healthy controls, the differences were statistically significant (both P1 (P=0.010) were increased. The levels of IL-6 in patients of male (P=0.003), stage Ⅲ-Ⅳ (P=0.008) or IPI>1 (P=0.004) were significantly higher. The level of hepcidin was highly correlated with serum ferritin (r=0.77, P<0.001), weakly correlated with IL-6 (r=0.31, P=0.030), and not correlated with Hb (r=-0.12, P=0.3). There was a negative correlation between IL-6 expression and Hb (r=-0.35, P=0.009). Multivariate analysis showed that IL-6 could predict anemia (P=0.03), whereas hepcidin could not (P=0.89). Conclusion The elevated hepcidin level is frequent in DLBCL, and the elevated IL-6 plays the major role in the development of anemia.
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Objective To evaluate the safety and effect of mechanical thrombectomy with the stent device in posterior circulation large intracerebral artery occlusions.Methods Arterial embolectomy with the stent device was carried out in 16 patients with posterior circulation large intracerebral artery occlusions(3.5 h than intravenous thrombolysis time window)in the NO.264th Hospital of People Liberation Army,including 8 cases with pure basilar artery occlusion,7 cases with bilateral vertebral artery intracranial segment and basilar artery occlusion,1 case with side of intracranial vertebral artery occlusion.The National Institutes of health neurological deficit score(NIHSS)score,Alberta stroke program early CT(ASPECTS)score,complications,clinical result were analyzed retrospectively.Results Among 16 cases,the time windows were from 7 to 18 h,the time from onset to reperfusion were(13.32±1.57)h.Successful recanalization was obtained in 15 patients(TICI=3),partial recanalization in 1 case(TICI=2a).Three cases with stent angioplasty.Survival in patients with NIHSS score decreased from(24.65±3.63)points on admission to(4.32±1.57)points after three weeks,with statistical difference(P＜0.01).For mRs score at 90 d: 6 cases(37.5％)with 0-1,4 cases(25％)with 2-3,2 cases(12.5％)with 4-5,4 cases died(25.0％,score ASPECTS 4-5).Conclusion The mechanical thrombectomy with the stent device within 24 h can get higher reperfusion rate,fewer complications,and significantly reduce the mortality rate and good clinical outcome in large intracerebral poster circulation artery occlusions patients.
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Objective To explore the effect of transcription factor SOX18 on proliferation, migration and invasion of HeLa cells and its related mechanism. Methods HeLa cells were divided into blank control group, negative control group, pCI-SOX18 group. The expression of SOX18 and matrix metalloproteinase 7 (MMP-7) was detected by Western blot. The cell proliferation of different group was measured by MTT analysis. The effect of transcription factor SOX18 on migration and invasion of HeLa cells were measured by Transwell assay. Results HeLa cells were successfully transfected with pCI-SOX18. According to the results of MTT analysis, the cell number of pCI-SOX18 group showed no significant difference compared with blank control group and negative control group (P> 0.05). Compared to blank control group (0.23 ±0.05) and negative control group (0.28±0.07), SOX18 expression in pCI-SOX18 group (1.16±0.13) was significantly higher (F=218.14, P<0.05). Meanwhile, MMP-7 expression in pCI-SOX18 group (0.95±0.09) was increased significantly compared with blank control group (0.71±0.07) and negative control group (0.68±0.06) (F=116.84, P < 0.05). The number of cell migration in pCI-SOX18 group (175.71 ±17.17) was increased significantly compared with that in negative control group (95.19 ±8.18) and that in blank control group (93.34±9.72) (t=75.47, t=77.35, P<0.05). Compared with that in negative control group (98.63±14.62) and that in blank control group (96.57 ±13.95), the number of cell invasion in pCI-SOX18 group (247.12 ±36.82) was significantly higher (t=98.02, t=99.34, P<0.05). Conclusion Overexpression of SOX18 has no effect on the proliferation of HeLa cells, but has a significant role in promoting cell migration and invasion probably by regulating MMP-7 expression positively.
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Objective:To evaluate the effects of rosiglitazone (ROS) on the expression of adiponectin receptors (AdipoR1 and AdipoR2) mRNA in gingival tissue and inflammatory factors,and on the potential of bone loss in the rats with experimental periodontitis.Methods:10 male Sprague-Dawley rats without treatment were used as the controls;40 were used for the creation of periodontis models and then treated by rosiglitazone at 0(periodontitis control),1,3,10 mg/kg(low,median and high dose groups) respectively 1/d for 4 weeks.RT-PCR was used to examine the expression of AdipoR1 and AdipoR2 mRNA in gingiva tissue.Levels of gingival TNF-α,MMP-9 and plasma adiponectin was measured by ELISA.CEJ-A was measured for the evaluation of alveolar bone loss by standard digital photographs.Results:The expression levels of gingival AdipoRl and AdipoR2 mRNA in periodontitis group is lower than that in the control group(P ＜ 0.01).The concentration of plasma adiponectin had no significant difference between control group and periodontitis group(P ＞ 0.05).The concentration of gingival TNF-α,MMP-9 in periodontitis group was significantly higher than that in control group (P ＜ 0.01).Compared with periodontitis group,ROS treatment increased the expression levels of AdipoR1 mRNA(P ＜ 0.05)and decreased the concentration of TNF-α in gingival tissue.Median and high dose treatment increased the expression levels of AdipoR2 (P ＜ 0.01) and the concentration of plasma adiponectin(P ＜ 0.05),decreased the concentration of MMP-9 in gingival tissue (P ＜ 0.01)and the alveolar bone loss(P ＜ 0.01).Conclusion:Rosiglitazone treatment may reduce inflammatory response and suppress the bone resorption probably through up-regulation of the expression of adiponectin receptors and decrease of the concentration of TNF-α,MMP-9 in gingival tissue.
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Objective To evaluate the safety and effectiveness of mechanical thrombectomy with Solitaire AB stent in the treatment of large intracranial artery occlusions.Methods The calinical data of 15 patients with acute stroke(more than 3.5 h intravenous thrombolysis time window) who were carried out arterial embolectomy with Solitaire AB stent in the No.264th Hospital of the Chinese People's Liberation Army were retrospective analyzed.There were 11 cases of middle cerebral artery(MCA),2 cases of internal carotid artery (ICA),1 case of vertebral artery(VA) pluse basilar artery(BA),and 1 case of anterior artery(AA).The recanalization occluded situation and surgical complications were analyzed,NIHSS score of preoperatively and at discharge were compared.Results In 15 cases,there were 14 cases of totally recanalization,1 case of partial recanalization.Two case with MCA stenosis and 1 case with VA stenosis after the recanalization were accepted stent angioplasty,2 csase died.NIHSS score of 13 cases survival patients increased from (22.85±4.75) scores on admission to (4.39 ±3.67) scores out of hospital,and the difference was statistically sinificant(t=2.752,P ＜0.01).Conclusion The mechanical thrombectomy with Solitaire AB stent can get high recanalization rate,fewer complications and good clinical outcome on patients with large intracranial artery occlusions.For more than venous or arterial thrombolysis time window,the mechanical thrombectomy can be considered within the 8 h after comprehensive evaluation.
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Objective To investigate the long-term effect of angioplasty of patients with symptomatic vertebrobasilar artery stent.Methods Thirty-three patients with symptomatic vertebral artery stenosis who underwent endovascular treatment stent.The clinical symptoms and stent restenosis were recorded.Results The clinical symptoms of 33 cases with angioplasty were improved significantly.The preoperative stenosis rate was (92.36 ±3.23)％ before operation and the average postoperative residual stenosis rate was (9.13 ±2.57)％ after operation.Clinical symptoms of 23 patients disappeared completely after operation,and 10 cases improved significantly.As to complications,1 case with severe basilar artery stenosis had a side numbness of extremities,1 case showed postoperative cerebral embolism,and return to normal after 3 days.When follow up periods lasted for 6-24 months,9 cases were with dizziness or other symptoms.Of which,29 cases were performed DSA imaging,the residual stenosis rate was (19.27 ± 5.62)％,3 cases of vertebral artery in-stent restenosis were reached over 50％.Those 3 cases were give stent angioplasty again and the uncomfortable symptoms disappeared.Conclusion Stenosis opeation can significantly alleviate the symptoms of cerebral ischemia and symptomatic vertebrobasilar artery,and improve the quality of life of patients.However,restenosis should paid more attention.
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Objective To investigate the effect of Solitaire stent combined with coils on endovascular embolization of intracranial wide-necked aneurysms.Methods Twenty-six cases with intracranial wide-necked aneurysms from June 2009 to December 2011 in the NO.264 Hospital of the Chinese People's Liberation Army were treated with Solitaire stent-assisted coils,and anticoagulation and antiplatelet therapy were done among peri operation period.The effect of endovascular embolization was evaluated after 3 months cerebral angiography.Results A total of 27 solitaire stent were used in the 26 patients,one of which used 2 stents.The stents were successfully put in place,and the placement effect were satisfaction.The immediate angiography showed that 24 cases were dense embolism,2 cases of subtotal embolization.Stent were placed at right position.Twenty-three patients were followed with DSA for 3 months,and no aneurysm evidence of recurrence was found.Conclusion Solitaire stent-assisted coil embolization of intracranial wide-necked aneurysms is simple to perform and embolism rate is high and the recurrence rate is low.
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Objective To explore the influence of the extract of wen-pi-tang on the memory and SOD and MDA of normal mice and cerebral ischemia reperfusion mice.Method The mice were divided into normal group,sham operation group,model group,aqueous extract and alcohol extract of wen-pi-tang (1.0 g/kg,0.5 g/kg,0.25g/kg).Model mice with cerebral ischemia reperfusion were made by blocking bilateral common carotid artery.The influence on memory behavior of normal mice and mice with cerebral ischemia reperfusion were tested by gavage for 10 days with extract of wen-pi-tang through step-down and step-through tests.Then SOD activity and content of the MDA were tested.Result In step-down test,compared with normal group,extract of wen-pi-tang with all doses made normal mice' latency longer,error frequency fewer,with high does clearest (P＜0.05)(latency:(187.17±99.00) s,(270.73±44.73) s,(260.45±63.78) s,error frequency(1.75± 1.71) times,(0.45±0.69) times,(0.75±0.97) times) ;in step-through test,compared with normal group,aqueous extract with high and middle doses and alcohol extract with longe doses could made latency of cerebral ischemia reperfusion mice longer and error frequency fewer (latency(157.15±84.91) s,(250.63±58.98) s,(251.12±78.22) s,(245±84.82) s,error frequency(2.15± 1.22) times,(0.75±0.89) times,(0.75± 1.16) times,(0.625 ±0.92) times) (P＜0.05) ; extract of wen-pi-tang with high and middle does increased SOD activity obviously compared with normal group(P＜0.05),and the content of MDA was obviously lower compared with normal group(P＜0.05,P＜0.01).Conclusion Extracts of wen-pi-tang can improve the memory function of normal mice,and the memory of cerebral ischemia reperfusion mice.The mechanism can be related to the increase of SOD activity and the decrease of the content of MDA.
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Objective To discuss the operative methods,clinical effect and safety of endovascular stenting in treatment of upra-arch extra intracranial artery stenosis.Methods Symptomatic carotid artery stenosis ＞ 50％,or no symptomatic stenosis ＞ 75％ with upra-arch extra intracranial artery stenosis patients were treated by endovascular stenting,of all patients,85 cases with carotid artery stenosis,37 cases with vertebral artery stenosis,6 cases with subclavian artery stenosis.Results One hundred and twenty-eight patients were treated with 130 vessel,used 131 stents,59 patients used vascular protection,the achievement rate of stent implantation was 100.00％.The degree of stenosis were significantly improved,the degree of stenosis from (87.65 ± 8.70)％ to (14.28 ± 4.87)％.Twenty-six patients appeared transient decline in blood pressure and heart rate,31 patients appeared persistent hypotension and decrease in heart rate.One patient (no using of vascular protection) appeared obhteration in ipsilateral middle cerebral artery,the artery was recanalization after thrombolysis treatment.The rest of 127 patients did not appear intraoperative vascular embolization complications.Eighteen patients appeared perioperative perfusion in transition,1 case happened cerebral hemorrhage (＜ 10 ml).Postoperative symptoms were improved significantly.Followed up for 6-36 months,84 patients had not restenosis in stent,1 patient had symptomless restenosis (＜ 50％).In 37 patients with vertebral artery stenosis,3 patients again appeared ischemia symptoms in postoperative 1 year,digital subtraction angiography (DSA) showed restenosis in stent,the patient was again given endovascular stenting,the symptoms disappeared.Conclusion As long as the correct choice of indications and perioperative treatment properly,the endovascular stenting in treatment of upra-arch extra intracranial artery stenosis has good clinical effect and high security.
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Objective To explore the functional orientation of township hospitals in developed areas to achieve goals of the ongoing health reform.Methods Two rounds of Delphi consultation was made among 18 experts from around the country to learn the degree of importance of every function.Results The experts' average seniority of service in their fields was 23.28±10.41 years.The positivity coefficients of the two-round consultation were 100％.Kendall' S coefficients of the two-round consultation were 0.226 and 0.265 (p＜0.01).These data are of statistical importance,suggesting consensus among these experts and the consultation meeting the needs of forecast.In these consultation,seven class-1 functions and and 27 class-2 functions were determined.Medical services and public health services account for similar proportion of work of township hospitals.Conclusion The functional orientation was feasible and forward looking,for reference of township hospitals in developed areas.
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A case of multiple keratoacanthoma centrifugum marginatum is first reported in China. A 37-year-old woman was admitted to the hospital for papules and plaques on her face, which had been increasing in number for 4 months. Cutaneous examination revealed dozenes of well-marginated, pale-red or skin-colored crateriform papules of variant size, and plaques in a geographic pattern on her face. The papules presented with a central umbilication filled with grey-brown corneous material. The plaques were surrounded by dyke-like borders, covered with thick, crusted brown corneous material, and partly depressed in the center. Histopathology showed hyperkeratosis, parakeratosis, irregular strip-like extension of epidermis into dermis, keratinous cysts and squamous eddies. The tumor cells had eosinophilic and glassy cytoplasm characteristic of keratoacanthoma.Given both the clinical and histologic evidence, a diagnosis of multiple keratoacanthoma centrifugum marginatum was made. After more than 3 months of treatment with oral acitretin and topical tretinoin, the lesions faded,leaving rugosity scars. No relapse was noted during 3-year follow-up.
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0.05)between DA and DE when the diameter of gel microspheres was20?m～40?m.CONCLUSI_ ON:The drug-loading pattern of BMP 2 -DEX-GMA gel microspheres can be influenced by its particle size,but its drug release character can not be changed,the controlled release of drugs can be achieved through changing the nature of its drug-loading material.
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OBJRCTIVE:To study the feasibility and the preparation of bone morphogenetic protein-2(BMP 2 )carrying gel microspheres by dextran-glycidyl methacrylate(DEX-GMA)and to make an initial study on the drug-loading and drug releasing function of gel.METHODS:The orthogonal test was conducted with the reaction temperature,the addition of DEX-GMA and Span-80,the stirring speed and so on as investigation factors,the best preparation technics of BMP 2 -DEX-GMA gel microspheres was optimized and the finished products of which were given an initial determination.RE-SULTS:The BMP 2 -DEX-GMA gel microspheres preparation could be made by suspension polymerization,the optimized preparation technics including the reaction temperature was30℃,the addition of DEX-GMA and Span-80were0.6%and0.06%respectively,the stirring speed was300r/min,the BMP 2 -DEX-GMA gel microspheres from the above formulation take good shapes with the particle diameter at20?m～50?m,the envelopment ratio was(78.52?4.34)%,the quantity of drug-loading was(10.68?1.34)%,and the swelling ratio was85.9%,which has a good stability and redispersibility.CON-CLUSION:The preparation technics of gel microspheres drug-loading system is simple and the loading dosage is high,which can be used as a bioactive drugs carrier.