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Objective:To investigate the preoperative evaluation, safety and clinical efficacy of intravascular recanalization for patients with symptomatic non-acute middle cerebral artery occlusion .Methods:Twenty-six patients with symptomatic non-acute middle cerebral artery occlusion admitted between January 2018 to June 2021 were retrospectively analyzed. The clinical symptoms, cerebral perfusion, occlusive site, occlusive length, collateral circulation and distal capillary were evaluated. There were 17 cases accorded with intravascular recanalization. The cerebral blood flow , cerebral blood volume, MTT, peak time and scores of 17 patients before and after revascularization were compared by paired t test.Results:Endovascular recanalization was performed in 17 patients and extracranial-intracranial artery bypass grafting was performed in 9 patients. Among the 17 cases, there were 7 cases of hemiplegia of contralateral limbs, 6 cases of recurrent cerebral infarction, 4 cases of paroxysmal contralateral limb numbness or weakness, 3 cases of cognitive dysfunction and 3 cases of headache. The cerebral perfusion of the occluded side of the middle cerebral artery in 17 cases was significantly lower than that of the healthy side. One patient failed to pass through the occlusion with micro guide wire, and gave up the operation after repeated attempts. The occluded vessels were successfully recanalized in 16 cases (thrombolytic grade of cerebral infarction=2b-3), and recanalized in 16 cases, including 9 cases of simple balloon dilatation and 7 cases of stent implantation. Three months after the operation, the National Institute of Health Stroke Scale (NIHSS) score of 17 patients decreased from (9.57±2.32) to (3.75±1.42). The cerebral blood flow, cerebral blood volume, mean transit time and peak time were also significantly improved compared with those before the operation（ t value was 9.08，5.54，4.26，8.56，6.00，respectively，all P<0.001）. The Montreal Cognitive Assessment (MoCA) score of cognitive function was (22.70±1.70) before the operation, and there months after operation (26.30±2.30) points ( t=6.66, P<0.001) were statistically significant. After operation, CT cerebral angiography or whole cerebral angiography showed that 1 case was occluded, 15 cases had good recanalization, no intracranial hemorrhage occurred during the perioperative period, and no new stroke occurred during the 6-month follow-up period. Conclusion:For patients with symptomatic non acute middle cerebral artery occlusion, the patients who may benefit from multi-dimensional evaluation are selected for intravascular recanalization treatment. There are few complications and high recanalization rate. The short-term follow-up clinical effect is good, but the long-term effect needs to be further observed.
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Non-acute intracranial artery total occlusion can lead to severe neurological defect and high recurrence rate of stroke.At present, there is no effective treatment recommended by the guidelines.Traditional treatment methods include medical therapy, extracranial-intracranial bypass surgery and minimally invasive endovascular recanalization therapy.In recent years, with the development of microsurgical vascular anastomosis technique and neurosurgical intervention, and the development of interventional materials, the treatment of non-acute intracranial artery total occlusion has become a hot spots.In this paper, the concept of non on-acute intracranial artery total occlusion, medical therapy, extracranial-intracranial bypass surgery and endovascular interventional therapy are reviewed.
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Acute ischemic stroke caused by posterior circulation occlusion is extremely dangerous, with a mortality rate of more than 90%.In recent years, mechanical thrombectomy had become an important method in the treatment of acute anterior circulation ischemic stroke, but whether it is effective and safe in the treatment of posterior circulation acute ischemic stroke is not clear.In this paper, the safety and effectiveness of intravascular treatment of acute ischemic stroke with posterior circulation occlusion were reviewed.
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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:Acute ischemic stroke (AIS) has a high incidence rate, high disability rate, high mortality and high medical expenses, which seriously affect the healthy living standard of our residents.Intravenous thrombolysis and mechanical thrombectomy within the time window are important methods for the treatment of AIS.The time window of mechanical embolectomy was extended from the initial 6 hours to 24 hours.The expansion of the time window enabled more patients to accept mechanical thrombectomy.However, some patients with more than 24 h time window have also achieved good results after strict multimodal evaluation.Therefore, there are some limitations in using time window to evaluate the indications of mechanical thrombectomy.In recent years, the way that time window combining with tissue window to evaluate the appropriate population of mechanical thrombectomy has become more and more popular.
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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 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 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 study the curative efficacy of Ningmitai capsule unite amsulosin hydrochloride sustained realeased capsules treatment ofⅢ type B prostatitis and its effects on level of the prostate fluid of interleukin-10(IL-10), tumor necrosis factor alpha, prostaglandin E2.Methods 104 patients withⅢtype B prostatitis who received therapy from December 2015 to October 2016 in our hospital were selected as research objects, according to the treatment were divided into observation group and control group , the observation group was treated with Ningmitai capsules unite Tamsulosin hydrochloride sustained realeased capsules while the control group was treated with Tamsulosin hydrochloride sustained realeased capsules.Comparison curative effect ,before and after the treatment of chronic inflammatory prostate integral index, maximum urinary flow rate, average urine flow rate;Analysis before and after treatment prostate fluid of interleukin-10, tumor necrosis factor alpha, prostaglandin E2 level and WBC count.Results After treatment, the observation group total effective rate was 90.4%, significantly higher than the control group (P<0.05);After treatment, the observation group in the prostatic fluid IL-10, the TNF-α, PGE-2, the WBC levels were significantly lower than the control group (P<0.05),and after the treatment,chronic inflammatory prostate integral index of observation group was obviously lower than the control group, the maximum urinary flow rate, average urine flow rate is significantly higher than the control group (P<0.05).Conclusion Ningmitai capsules unite amsulosin hydrochloride sustained realeased capsules treatment Ⅲ type B prostatitis has significantly clinical curative effect, can pass down the prostate fluid of IL-10, the TNF alpha, PGE-2 levels, relieve the clinical symptoms.
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Objective To explore the value of ureteroscopy in the diagnosis and treatment of ureteral injury caused by laparoscopic hysterectomy . Methods Suspect ureteral injury occurred in 23 cases out of 578 laparoscopic hysterectomy from January 2010 to December 2015 in our hospital.Among them, 12 cases were testified by ureteroscopy .A double-J catheter was placed in for 3 months. Results All the 12 cases were followed up for 3-26 months (average, 19 months).The double-J catheter was removed at 3 months after surgery .The continuity of the affected side urinary tract was restored in 10 cases and hydronephrosis was not found by B ultrasound .Two cases were found ureteral obstruction and were given ureterovesical reimplantation at 3 months after surgery . Conclusions The ureteroscopy should be carried out as early as possible for patients with suspect ureteral injury after laparoscopic hysterectomy .Double-J catheter placement can avoid parts of patients converting to open surgery .
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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 study the changes of serum levels of soluble vascular adhesion protein (sVAP-1), hyaluronic acid (HA) in chronic hepatitis C (CHC) patients, to analysis the relationships between serum sVAP-1 and liver function、HA ,to explore the role of sVAP-1 on the pathogenesis of CHC. Method In our research, 88 cases CHC patients were divided into 2 groups,30 cases serum HCV RNA negative (CHC1 gruop)、58 cases serum HCV RNA opsitive (CHC2 gruop);30 cases healthy individuals were enrolled in our research;the serum levels of sVAP-1 and HA were determined by ELISA; Liver function was assayed by automatic biochemistry analyzer;HCV RNA load was measured by real-time polymerase chain reaction (PCR). Results In CHC1,CHC2 and healthy control groups,serum level of sVAP-1 were (112.75 ± 39.00),(154.24 ± 45.88)and (72.23 ± 35.82) ng/mL(F=38.76,P<0.01),respectively; serum level of HA were(87.03 ± 24.95),(132.98 ± 33.54)and (75.07 ± 24.09)ng/mL,respectively (F=47.44,P<0.01);The concentrations of serum sVAP-1、 HA gradually had been increasing with level of ALT (all P<0.05);Especially,significantly positive associations were highly between serum sVAP-1 and ALT 、AST and HA (r=0.711、0.628、0.816, all P<0.001). Conclusion Serum sVAP-1 may be closely related to the hepatic cell inflammatory injury and liver fibrosis in CHC patients.
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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 evaluate the possibilities of using circulating miR-155-5p, miR-21-5p, miR-29a and miR-142-5p as biomarkers for the diagnosis of active pulmonary tuberculosis (TB).Methods Plasma samples were collected from 60 healthy subjects, 40 patients with active pulmonary TB and 20 sub-jects with latent tuberculosis infection ( LTBI) to extract miRNAs.The levels of miR-155-5p, miR-21-5p, miR-29a and miR-142-5p in plasma samples were detected by using reverse transcription-quantitative PCR. Results The levels of miR-155-5p, miR-21-5p and miR-29a in patients with active pulmonary TB were re-spectively 10.13, 7.34 and 2.74 times as much as those in healthy subjects(P<0.05).No significant differences with the level of miR-142-5p were observed between the two groups.The receiver operating char-acteristic (ROC) curve analysis of miR-155-5p, miR-21-5p and miR-29a in patients with active pulmonary TB and healthy subjects showed that the areas under the curve (AUC) were respectively 0.905, 0.830 and 0.687.The level of miR-155-5p in patients with LTBI was 3.1 times than that in healthy subjects ( P<0. 05).No differences with miR-21-5p, miR-29a and miR-142-5p were found between patients with LTBI and healthy subjects.The levels of miR-155-5p, miR-21-5p and miR-29a in patients with active pulmonary TB were respectively 3.26, 6.69 and 1.98 times than those in patients with LTBI (P<0.05).The rate of LTBI was 40.58%in people who were in close contact with patients with active pulmonary TB.Conclusion Sig-nificant differences with the levels of miR-155-5p, miR-21-5p and miR-29a were observed among healthy subjects, patients with active pulmonary TB and patients with LTBI, but no difference with the level of miR-142-5p was observed among them.miR-155-5p, miR-21-5p and miR-29a could be used as the potential bio-markers for the diagnosis of active pulmonary tuberculosis and latent tuberculosis infection.People who were in close contact with patients with active pulmonary TB could have a higher LTBI rate.
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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 evaluate the diagnostic value of physical examination,digital mammography and color Dopplor ultrasonography for breast masses.Methods The materials of clinic,digital mammography and color Dopplor ultrasonogrpahy(US)in 92 women(raged from 18～80 years old in age,with average of 49.8 years old)with breast masses confirmed by pathology were retrospectively analysed,including benign in 43 and malignant in 49.Digital mammographic findings including the location,shape,margins,calcifications and the lymph node of axillary of the breast lesions,and color Dopplor ultrasonographic findings including mainly the characteristics of lesions on two-dimensional sonography,the distribution of the internal and peripheral vessels of the lesions were observed,the physical examination mainly observed the skin and nipple,and the margins,texture and movement of the lesions.Results In diagnosing breast masses,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 85.71%,79.07%,82.35%,82.93% and 82.61%,respectively with digital mammography,79.59%,83,72%,84.78%,78.26% and 81.52%,respectively with US,71.42%,76.74%,77.78%,70.21%,73.91%,respectively with physical examination,while were 91.84%,93.02%,93.75%,93.3% and 90.91%,respectively in combination with three methods,which were significantly higher than that of each single examination(P＜0.05),but there were no differences between each examination(P＞0.05).Conclusion It can improve the diagnosing accuracy of breast masses by suitable combination of three of digital mammography,color Dopplor ultrasonography and physical examination.
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This study was designed to determine the effect of backpack loading on the gait pattern and corresponding compensatory strategy, which is important to the balance control of biped robot and military training. Five healthy subjects were instructed to walk at their preferred speed on level pathway taking three different loads i.e. 6 kg, 12 kg and 25 kg, on their backs. The results showed that the gait pattern was apparently influenced, and the dominant effects were found to be the flexion of hip, knee joints and pitch angle of torso. The stride speed decreased apparently with loading on their backs, but the stride length showed less changes. Besides, the responses to taking loads might be influenced by the strength of body. An apparent multi-joints coordination motor mode was employed to compensate the influences of loading, however, their contributions are different; hip, knee joints and torso pitch made dominant contributions to the compensation while ankle joints made minor. The anterior pitch of upper torso could be employed to adjust the overall center of mass while loading on their backs, the larger the magnitude of loading on their backs, the larger the anterior pitch angle of torso. After the heel touched the ground, the flexion of hip and knee joints were effective for the shock absorption, which means that the stiffness of hip and knee joints can be used to absorb the shock and avoid the trauma of each joints.