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Objective To observe the clinical effect of hemoperfusion in the treatment of patients with critical severe organophosphorus poisoning. Methods Sixty-two patients with critical severe organophosphorus poisoning admitted to the Department of Critical Care Medicine of Jincheng People's Hospital from August 2016 to August 2018 were enrolled, and they were divided into a routine treatment group and a hemoperfusion group according to whether hemoperfusion or not, 31 cases in each group. The routine treatment group was treated with western drugs combined with continuous gastric lavage, while the hemoperfusion group was additionally treated with hemoperfusion for consecutive 3 days on the basis of the routine emergency regimen. The changes of the dosage of penehyclidine hydrochloride used, recovery time of consciousness, recovery time of cholinesterase (ChE) activity, off-line time of mechanical ventilation, hospitalization time, poisoning rebound and mortality were observed in the two groups after treatment; Glasgow coma scale (GCS) was used to assess the prognosis of patients. Results The dosage of penehyclidine hydrochloride used in hemoperfusion group was less than that in the routine treatment group (mg: 3.1±1.2 vs. 5.8±1.3), and the time of consciousness recovery (hours: 3.3±1.7 vs. 13.4±2.4), recovery time of ChE activity (days: 7.7±1.5 vs. 17.9±3.3), off-line time (days: 2.1±0.9 vs. 7.5±2.6), hospitalization time (days: 12.3±1.5 vs. 19.8±3.6) in hemoperfusion group were shorter than those in the routine treatment group (all P < 0.05); poisoning rebound [3.23% (1/31) vs. 16.13% (5/31)] and mortality [9.68% (3/31) vs. 25.81% (8/31)] in hemoperfusion group were lower than those in the routine treatment group (both P < 0.05). The Glasgow coma score (GCS) of the hemoperfusion group on 3, 4 and 5 days after treatment were all higher than those of the routine treatment group (9.9±2.9 vs. 5.7±2.6, 13.3±2.7 vs.7.8±3.2, 13.3±1.5 vs.9.3±2.6, all P < 0.05). Conclusion The conventional treatment, western drug and gastric lavage, combined with hemoperfusion in patients with critical severe organophosphorus poisoning can further reduce the hospital stay, improve the quality of life and reduce the mortality of such patients, therefore.
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Objective To investigate the efficacy and influence factors of uterine artery embolization (UAE)in treatment of intractable postpartum hemorrhage (PPH).Methods 126 patients with intractable PPH were treated by UAE in our hospital.We analyzed the influence factors of failed UAE treatments according to the amount of bleeding,the stability of hemodynamics,with disseminated intravascular coagulation(DIC)or not and active extravasation detected in angiography.Results In 126 intractable PPH patients,13 cases (10.3%) failed to stop bleeding after UAE and the other 113 cases (89.7%)successfully got hemostasis.Logistic regression analysis showed that DIC was a significant factor in failed UAE group (P=0.033,OR 0.107,95%CI 0.014-0.835).Conclusion UAE is an effective method of treating intractable PPH.DIC may be the main cause of the failure of UAE in treatment of intractable PPH.
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BACKGROUND:It is difficult to perform superselective catheterization of the internal carotid artery in dogs because of the large bending and spiral shape of the interal carotid artery before entering into the skul. At present, the dog models of cerebral infarction established by injecting autologous blood clots and gelatin spongevia the internal carotid artery are far from the perspective of pathological mechanism of human patients with cerebral infarction. Aortography can visualize the structure of cerebral vessels and is likely to provide a new condition for the establishment of dog models of acute cerebral infarction. OBJECTIVE:To explore the feasibility of establishing cerebral infarction models in beagle dogs by superselective catheterizationvia the vertebral basilar artery. METHODS: Five beagle dogs were divided into thrombus group (n=3) and control group (n=2). The beagle dogs in the thrombus group were subjected to digital subtraction angiography of the aortic arch, bilateral common carotid arteries and vertebral arteries in addition to femoral arterial catheterization. The 2.7F micro-catheter was inserted into the convergence zone of the left posterior communicating artery and the internal carotid artery through the vertebrobasilar artery. An autologous blood clot was injected into the convergence zone. The dogs in the control group were injected with appropriate amount of contrast medium. RESULTS AND CONCLUSIONS:Through angiography of the left and right common carotid artery of five dogs, thick external carotid arteries (10/10) and their branches were clearly displayed, however, only five (5/10) internal carotid arteries were dimly present. A spiral vascular loop formed in the internal carotid artery with a smal-sized diameter. Through antiography of the left and right vertebral arteries (10/10) angiography, vertebral basilar artery, the circle of “Wilis”, bilateral posterior cerebral arteries, bilateral middle cerebral arteries and bilateral anterior cerebral arteries were clearly displayed, al these contribute to insertion of microcatheter into the convergence zone of the left posterior communicating artery and the internal carotid artery through the vertebrobasilar artery. High signal intensity of the left temporal lobe was shown on 3-hour and 6-hour diffusion weighted images.The results demonstrate that the beagle dog models of acute cerebral infarction can be successfuly established by injecting autologous blood clots into the left middle cerebral artery through a microcathter insertedvia the vertebrobasilar artery, which provides a new method of precisely occluding the middle cerebral artery of beagle dogs by catheterization.
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BACKGROUND:In order to avoid distal arterial embolism fol owing mechanical thrombectomy, micro-bal oon catheter temporary isolation is applied to prevent thrombus shedding. OBJECTIVE:To investigate the safety and feasibility of adopting the micro-bal oon catheter technique in treatment of the hyperacute cerebral infarction. The micro-bal oon catheter technique can temporarily block the artery blood flow and isolate the embolism location fol owing mechanical thrombectomy and aspiration combined with thrombolysis. METHODS:Ten beagle dogs were included in this study. Under general anesthesia, the micro-bal oon catheter was delivered to the dominant vertebral artery through the femoral artery in al the dogs and it was fil ed and temporarily blocked the blood flow. Then the autologous thrombus was injected through the micro-catheter into proximal vertebral artery to make a thrombosis model. Al the dogs were equal y divided into two groups according to the embolectomy method:control group (receiving pure stent embolectomy, n=5) and experimental group (n=5). The experiment group was disrupted and aspirated thrombus combined with the drug thrombolysis after temporarily blocking out the blood flow and isolating the target artery by micro-bal oon catheter technique. After treatment, two groups underwent digital subtraction angiography to review the vertebral artery recanalization after different embolectomy methods. The hemodynamic status was evaluated through the thrombolysis in cerebral ischemia grade. Al the dogs were scanned with magnetic resonance diffusion weighted imaging before modeling and at 12 hours after the thrombectomy. The animals were kil ed to perform pathological examination after magnetic resonance diffusion weighted imaging (12 hours after the thrombectomy). The vessel recanalization rates and complications were calculated in the two groups. RESULTS AND CONCLUSION:The thromboembolism model was successful y established in the dominant vertebral artery of al the 10 beagle dogs. In the control group, the vertebral arteries were completely successful recanalized in two dogs and were partly recanalized in three dogs, while the vertebral-basilar and intracranial arteries in one dog showed multiple smal punctate fil ing defects with poor intracranial arterial development and contrast agent reflux. At 12 hours after embolectomy, the magnetic resonance diffusion weighted imaging showed slightly high signal intensity at the left temporoparietal lobe and the pathologic examination suggested thrombosis in the cerebral artery lumen of the left temporal lobe. In the experimental group, the vertebral arteries in five dogs were completely recanalized without infarction. The revascularization rate in the experimental group was significantly higher than that in the control group (P<0.05). Experimental findings indicate that, the application of disruption and aspiration thrombus combined with the drug thrombolysis after temporarily blocking the blood flow and isolating the target artery by micro-bal oon catheter technique in treatment of hyperacute cerebral infarction, can effectively prevent the smal embolus exfoliating, which can cause distal embolization. Thus, the micro-bal oon catheter technique is a safe, effective and relatively inexpensive interventional embolectomy.
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Objective:To investigate the clinical significance of epidermal growth factor receptor(EGFR),proliferating cell nuclear antigen(PCNA),laminin(LN)and type IV collagen expression in salivary adenoid cystic carcinoma(SACC).Methods:EGFR gene in 78 cases of SACC with complete clinical data was detected by fluorescence in situ hybridization(FISH)technique,the expression of EGFR,PCNA,LN and type IV collagen protein was detected by immunohistochemistry technique(IHC),their correlation with the clin-icopathological parameters was analysed by SPSS 13.00 software.Results:EGFR gene amplification levels(69.2%)was positively related to the ratio of EGFR protein positive expression(7 1 .8%),the expression of EGFR,PCNA,LN and type IV collagen was posi-tively related to the clinical pathological parameters(P<0.05).There was a positive correlation between EGFR and PCNA expression (P<0.05),a negative correlation between LN protein and type IV collagen protein expression(P<0.05).Conclusion:EGFR gene is amplified in SACC.EGFR,PCNA,LN and type IV collagen take part in the occurrence and development of SACC.