Résumé
Objective:To investigate the predictive factors of early neurological deterioration (END) in patients with single subcortical infarction (SSI).Methods:Consecutive patients with SSI within 12 h of onset admitted to the Department of Neurology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from January 2016 to December 2021 were included retrospectively. The clinical and imaging data of the END and non-END groups were collected and compared. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Results:A total of 1 060 patients with SSI were included, of which 268 (25.28%) developed END. There were statistically significant differences in the infarct involving internal capsule on diffusion-weighted imaging, SSI classification, maximum diameter and classification of the infarcts, and the number of infarct layers between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that the infarct involved the internal capsule (odds ratio [ OR] 1.52, 95% confidence interval [ CI] 1.27-1.96; P=0.015), the maximum diameter of the infarct ( OR 1.33, 95% CI 1.12-1.42; P=0.023), proximal SSI ( OR 1.49, 95% CI 1.28-1.92; P=0.018), and the number of infarct layers (compared to 1 layer, 3 layers: OR 15.01, 95% CI 4.12-12.45, P=0.013; ≥ 4 layers: OR 15.42, 95% CI 5.67-18.43, P=0.004) were independent risk factors for END. Conclusion:Infarct involved internal capsule on diffusion-weighted imaging, larger diameter of the infarct, proximal SSI, and ≥3 layers of infarct may be predictive factors of the occurrence of END in patients with SSI.
Résumé
Objective:To investigate the efficacy and safety of tirofiban in patients with acute ischemic stroke (AIS) with early neurological deterioration (END).Methods:Consecutive patients with AIS who had END and did not receive reperfusion treatment admitted to Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University within 24 h of onset from January 2017 to December 2022 were retrospectively included. END was defined as an increase of ≥2 in the National Institutes of Health Stroke Scale score within 72 h after onset compared at admission, or an increase of 1 in motor function. The tirofiban group was given tirofiban within 2 h after the occurrence of END, while the control group was given aspirin+clopidogrel. A score of ≤2 on the modified Rankin Scale at 90 d after onset was considered as a good outcome.Results:A total of 502 patients with AIS who had END were enrolled; including 322 males (64.14%) aged 65 ± 9 years. There was no statistically significant difference in baseline characteristics between the tirofiban group ( n=252) and the control group ( n=250). The good outcome rate of the tirofiban group at 90 d was significantly higher than that of the control group (60.32% vs. 42.00%; P<0.05), while there were no statistically significant differences in the incidence of symptomatic hemorrhagic transformation, asymptomatic hemorrhagic transformation, death and serious adverse events within 90 d. There were statistically significant differences in diabetes, atrial fibrillation, use of tirofiban, and the classification of stroke etiology between the good outcome group and the poor outcome group ( P<0.05). Multivariate logistic regression analysis showed that the use of tirofiban was an independent correlated factor for good outcome (odds ratio 0.33, 95% confidence interval 0.22-0.48; P<0.001). Conclusion:Tirofiban has good efficacy and safety for END in patients with AIS who did not received reperfusion therapy.
Résumé
Objective:To investigate the correlation between fibrinogen and lipoprotein (a) and early neurological deterioration (END) in acute ischemic stroke patients with diabetes.Methods:From January 2017 to December 2020, patients with acute ischemic stroke admitted to the Department of Neurology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University within 48 h of onset were enrolled retrospectively. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score within 7 d after onset increased by ≥2 or motor function score increased by ≥1 compared with the baseline. Demographic and baseline clinical data were collected. Multivariate logistic regression analysis was used to identify the independent risk factors for END in general and diabetic patients with acute ischemic stroke. Results:A total of 1 504 patients with acute ischemic stroke were enrolled. Two hundred and fifty-two (16.76%) patients had END. The age, baseline NIHSS score, random blood glucose, fibrinogen, lipoprotein (a) levels, and the proportion of patients with diabetes in the END group were higher than those in the non-END group. There were also significant differences in various stroke etiologic subtypes between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that fibrinogen and lipoprotein (a) levels were not the independent risk factors for END in patients with acute ischemic stroke. Three hundred and thirty-seven patients also had diabetes mellitus, of which 85 had END (25.22%). The levels of fibrinogen and lipoprotein (a) in the END group were significantly higher than those in the non-END group ( P<0.05). Multivariate logistic regression analysis showed that fibrinogen (odds ratio 2.23, 95% confidence interval 1.75-4.54; P=0.002) and lipoprotein (a) (odds ratio 1.98, 95% confidence interval 1.57-3.65; P=0.003) were the independent risk factors for END in acute ischemic stroke patients with diabetes. Conclusion:Higher fibrinogen and lipoprotein (a) levels are associated with END in acute ischemic stroke patients with diabetes.
Résumé
Objective To investigate the effect of octanol,a gap junction blocker,on mitogen activated protein kinase (MAPK) signal pathway after ischemia reperfusion in rats.Methods Seventy-two male SD rats were randomly divided into sham-operated group,DMSO control group,saline control group and octanol group (n=1 8).The focal cerebral ischemia reperfusion models were established by suture method in the later three groups.Rats were injected 5 mmol/kg octanol solution (5％ octanol soluble in 5％ DMSO solution) into the abdominal cavity of rats in the octanol group 30 min before ischemia reperfusion;rats in the DMSO control group were injected with same amount of 5％ DMSO solution,and those in the sham-operated group and saline control group were injected with same amount of saline.At 24 h after reperfusion,Neurological Function Defect Scale was performed;water content in brain tissues was detected by dry-wet method;cerebral infarction volume percentage was detected by TTC staining;the total protein expressions of extracellular signal-regulated kinase 1/2 (ERK1/2),c-jun amino-terminal kinase (JNK),and p38,and protein expressions ofphosphorylased (p)-ERK1/2,p-JNK,and p-p38 were detected by Western blotting.Results The scores of Neurological Function Defect Scale,water content in brain tissues,and infarction volume percentage of the octanol group (1.583±0.651,78.363％±0.672％,and 24.34％±0.19％) were obviously reduced as compared with those in the DMSO control group (2.344±0.743,80.873％±0.831％,and 32.26％±0.21％) and saline control group (2.351±0.732,80.893％±0.734％,and 32.28％±0.24％),with significant differences (P＜0.05).The protein expressions ofp-ERKl/2,p-JNK,and p-p38 in the octanol group (0.201±0.009,0.211±0.011,and 0.191±0.009) were obviously reduced as compared with those in the DMSO control group (0.389±0.019,0.311±0.022,and 0.309±0.021) and saline control group (0.393±0.021,0.304±0.021,and 0.316±0.025),with significant differences (P＜0.05).Conclusion Octanol can reduce ischemic reperfusion injury,whose mechanism may be related to the regulation of MAPK signal pathway.
Résumé
Objective To investigate the effects of octanol,a gap junction blocker,on the levels of pro-inflammatory cytokines after cerebral ischemia-reperfusion in rats.Methods Seventy-two male SD rats were randomly divided into sham operation group,saline control group,vehicle group,and octanol intervention group (n =18 in each group).The model of transient middle cerebral artery occlusion was induced by the modified suture method.The octanol intervention group was intraperitoneally injected with octanol solution at 5 mmol/kg body weight 30 min before ischemia.The saline control group and the vehicle group were intraperitoneally injected with the same amount of physiological saline and 5％ dimethyl sulfoxide solution 30 min before procedure.The neurological deficit score,brain water content,and cerebral infarction volume in each group were detected after ischemia for 2 h and reperfusion for 24 h.Enzyme-linked immunosorbent assay was used to detect the serum interleukin (IL)-1β,IL-6,and tumor necrosis factor-α (TNF-α) levels.Results Compared with the saline control group and the vehicle group,the neurological deficit score of the octanol intervention group was significantly lower (all P ＜0.05),the brain tissue water content was significantly decreased (P ＜ 0.05),the cerebral infarction volume was significantly reduced (P ＜0.05),and the expression levels of IL-1β,IL-6,and TNF-α were significantly decreased (all P ＜0.05).There were no significant differences in neurological deficit score,brain water content,cerebral infarction volume and serum IL-1 [β,IL-6 and TNF-α levels between the saline control group and the vehicle group.Conclusion Gap junction blocker octanol can reduce cerebral ischemic-reperfusion injury.Its mechanism may be related to the alleviation of inflammatory response.
Résumé
Objective To compare the effects of different analgesic methods in patients undergoing hip surgery followed by low-molecular-weight heparin administration.Methods A total of 94 ASA Ⅰ-Ⅱ patients undergoing hip surgery with combined spinal and epidural anesthesia (CSEA) who had received a single dose of 2 mg epidural morphine were randomized into 3 groups:Group M (n=30,patients receiving a single dose of epidural morphine combined with intramuscular tramadol if VAS≥4),Group E [n=34,patients receiving a single dose of epidural morphine combined with patient-controlled epidural analgesia (PCEA)],and Group Ⅰ [n=30,patients receiving a single dose of epidural morphine combined with patient-controlled intravenous analgesia (PCIA)].Infusion quantity during operation,bleeding volume and postoperative drainage volume,visual analogue scales (VAS) 24 h and 48 h after operation,Ramsay sedation scores,and nausea and vomiting were recorded.Venous blood samples were taken at admission,the end of operation,and 24 h,48 h and 7 d after operation for hemorheological data,coagulation tests and blood platelet counts (PLT).Color Doppler ultrasonography of lower limb vessels was conducted by the same clinician before and 7 days after operation.Results VAS at 48 h after operation were higher in Group M than in Group E and Group Ⅰ,and there were more patients refusing to initiate ambulation because of pain in Group M than in Group E and Group Ⅰ (P＜0.01).Ramsay scores at 24 h and 48 h in Group Ⅰ were higher than those in Group M and Group E,and there was no significant difference in Ramsay scores between Group M and Group E (P＞0.05).The occurrence of post-operative nausea and vomiting (PONV) was higher in Group M and Group Ⅰ than in Group E (P＜0.05),and there were more patients refusing to initiate ambulation because of nausea and vomiting in Group M and Group Ⅰ than in Group E (P＜0.01).There was no significant difference in DVT occurrence,hemorheological parameters or coagulation function between the 3 groups (each P＞0.05).Conclusions A single dose of epidural morphine does not achieve satisfactory analgesia,as evidenced by a large proportion of patients refusing to initiate rehabilitation training due to pain,and the incidence of PONV is high in elderly patients undergoing hip surgery.A single dose of epidural morphine combined with PCIA offers enhanced analgesia,but it also results in increased PONV.A single dose of epidural morphine combined with PCEA provides improved analgesia and reduced PONV,but shows no added advantage with the application of low-molecular-weight heparin in deep venous thrombosis prevention.
Résumé
Objective To investigate the treatment of octanol on matrix metalloproteinase-9(MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) protein expression,cerebral water content,infarction volume after ischemia-reperfusion in rats.Methods 150 SD rats were randomly divided into sham operated group (n=24),MCAO group (n=24),DMSO solvent control group (n=24) and octanol treatment group (n=24).A model of middle cerebral artery occlusion was induced by suture method.TTC stain was used to detect the infarction volume,dry-wet weight method to determine the brain water content.The expression of MMP-9 and TIMP-1 protein was detected by immunofiuorescence and Western blot.Results At 24 h of reperfusion after ischemia for 2 h,the octanol treatment group compared with MCAO group brain infarction volume obviously decreased(P＜0.05),water content significantly reduced ((78.16± 1.47) ％ vs (80.88±0.73) ％,P＜0.05),the number of MMP-9 positive cells obviously decreased((10.67±2.16) vs (29.00±3.40),P＜0.05),the expression of MMP-9 protein significantly reduced ((0.14±0.01) vs (0.21±0.02),P＜0.05)and the number of TIMP-1 positive cells significantly increased ((27.83 ±2.13) vs (5.67± 1.03),P＜0.05),the expression of TIMP-1 protein obviously increased((0.42±0.01) vs (0.28± 0.01),P＜0.05).The difference between MCAO group and DMSO solvent control group was not statistically significant(P ＜0.05).Conclusion Octanol may reduce brain edema,brain infarction volume.Up-regulation the expression of MMP-9 and down-regulation the expression of TIMP-1 may be one of the underlying mechanisms of the octanol neuroprotection.
Résumé
Objective To investigate the relationship between the serum apolipoprotein B (ApoB)/ ApoA-Ⅰ ratio and intracranial artery stenosis in young patients with ischemic stroke.Methods Patients with ischemic stroke aged from 18 to 45 were enrolled in the study.Brain CT angiography was used to evaluate the degree of intracranial artery stenosis,and the concentrations of serum total cholesterol,triglyceride,highdensity lipoprotein cholesterol,low-density lipoprotein cholesterol,ApoA-Ⅰ,and ApoB were detected.The ratio of ApoB/ApoA-Ⅰ was calculated.The Demographic and clinical characteristics of the intracranial artery stenosis group and the non-intracranial artery stenosis group were compared.Multivariate logistic regression analysis was used to identify the independent risk factors for intracranial artery stenosis in young patients with ischemic stroke.Results A total of 161 young patients with ischemic stroke were enrolled,including 89 in the intracranial artery stenosis group and 72 in the non-intracranial artery stenosis group.The constituent ratios of diabetes mellitus (20.2％ vs.6.9％;x2 =4.641,P =0.032),smoking (47.5％ vs.15.2％;x2 =15.121,P=0.001),hyperlipidermia (56.1％ vs.48.6％;x2 =4.197,P=0.040),as well as the radios in serum high-density lipoprotein cholesterol (1.29 ± 0.30 mmol/L vs.1.65 ± 0.34 mmol/L;t =7.131,P=0.002),ApoA-Ⅰ (1.49 ± 0.65 g/L vs.1.63 ± 0.23 g/L;t =2.751,P =0.001),ApoB (1.49 ± 0.65 g/L vs.1.63±0.23 g/L;t=2.751,P=0.001),and ApoB/ApoA-Ⅰ ratio (1.49±0.65 vs.1.63± 0.23;t =2.751,P=0.001) had significant differences between the two groups.Multivariate logistic regression analysis showed that diabetes (odds ratio [OR] 3.052,95％ confidence interval [CI] 1.186-7.856;P =0.021),smoking (OR 2.997,95％ Cl 1.456-6.172;P =0.003),hyperlipidemia (OR 4.745,95％ CI 2.108-10.668;P =0.001),ApoB (OR 4.861,95％ CI 3.029-7.802;P=0.001),and ApoB/ ApoA-Ⅰ ratio (OR 5.684,95％ CI 2.215-14.584;P=0.002) were the independent risk factors for intracranial artery stenosis in young patients with ischemic stroke,while HDL-C (OR 0.561,95％ CI 0.354-0.888;P=0.014) and ApoA-Ⅰ (OR 0.065,95％ CI 0.010-0.409;P=0.004) were the independent protective factors.After adjustment for hypertension,diabetes,smoking,hyperlipidemia,HDL-C,ApoA-Ⅰ,and ApoB,ApoB/ApoA-Ⅰ ratio was still an independent risk factor for intracranial artery stenosis in young patients with ischemic stroke (each increase of 1 standard deviation,OR 4.255,95％ CI 2.348-7.711;P=0.001).Conclusion ApoB/ApoA-Ⅰ ratio is an independent risk factor for intracranial artery stenosis in young patients with ischemic stroke.
Résumé
Objective To observe the effect of duration of carbon dioxide pneumoperitoneum on coagulation, fibrinolysis and endothelial activation in elderly patients undergoing laparoscopic cholecystectomy (LC). Methods The 45 elderly patients with cholelithiasis scheduled for LC, aged over 60 yeas, were placed in different groups respectively after surgery according to the duration of pneumoperitoneum. The duration of pneumoperitoneum was ≤60 minutes in group A (n=21),and more than 60 minutes in group B (n=24). Venous blood samples were taken on admission (baseline), at the end of surgery, the 1st, 2nd and 3rd day after surgery for determination of prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin fragment F1+2 (F1+2), antithrombin 3 (AT-Ⅲ activity), fibrinogen (Fib), tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-1), D-dimer (D-D), von Willebrand factor (vWF activity). Results Concerning the coagulation activation, at the 3rd postoperative day, the level of F1+2 was significantly higher in group B than in group A [(1.60±0.26) μg/L vs. (1.32±0.24) μg/L, P＜0.05]; AT-III was significantly higher in group B than in group A [(84.82%±20.21%) vs. (97.49%±16.87%), P＜0.05]. At the 2nd and 3rd postoperative day, the levels of Fib were significantly higher in group B than in group A [(3.87±0.62) g/L vs. (3.42±0.72) g/L, (3.98±0.77) g/L vs. (3.42±0.63) g/L, respectively, P＜0.05]. Concerning fibrinolysis, But at the 2nd and 3rd postoperative day, the level of PAI-1 was significantly higher in group B than in group A [(33.93±10.42) μg/L vs. (26.69±9.49) μg/L, (32.90±11.25) μg/L vs. (26.31±7.06) μg/L respectively, P＜0.05]. Concerning endothelial activation, at the 2nd and 3rd postoperative day, vWF was significantly higher in group B than in group A [(174.53%±44.03%) vs. (134.37%±37.74%), (176.31%±47.6%) vs. (131.21%±36.34%), respectively, P＜0.05]. Conclusions Marked activations of coagulation-fibrinolysis and endothelial activation are observed postoperatively in elderly patients undergoing laparoscopic cholecystectomy. Along with prolonged duration of pneumoperitoneum, more pronounced alterations of increased coagulation, reduced fibrinolysis and endothelial activation are observed, which could constitute an imbalanced situation of coagulation-fibrinolysis and increases the risk of venous thrombosis.
Résumé
Objective To compare the changes in blood coagulation, fibrinolysis and endothelial damage in patients undergoing laparoscopic cholecystectomy with different durations of carbon dioxide pneumoperitoneum. Methods Sixty-four ASA Ⅰ orⅡpatients, aged 23-60 yr, weighing 45-82 kg, scheduled for elective laparoscopic cholecystectomy, were randomly divided into 3 groups according to the duration of pneumoperitoneum: duration of pneumoperitoneum ≤30 min group (group Ⅰ, n=21), 30 min ＜ duration of pneumoperitoneum ＜ 60 min (group Ⅱ, n=23) and duration of pneumoperitoneum≥ 60 min (group Ⅲ , n=20).The intra-abdominal pressure was maintained at 12-14 mm Hg. Venous blood samples were taken before surgery (baseline, T0 ),at the end of surgery(T1), and at 1, 2 and 3 d after surgery (T2-4) for determination of prothrombin time, activated partial thromboplastin time, concentrations of prothrombin fragment 1+2(F1+2), fibrinogen (Fib), tissue plasminogen activator and plasminogen activator inhibitor type-1 (PAI-1), and activities of antithrombin Ⅲ(AT-Ⅲ)and von Willebrand factor(vWF).Results Compared with groupⅠ , the vWF activity and PAI-1 concentration at T2 , concentrations of Fib, F1+2, PAI-1 and activity of vWF at T3 and concentrations of Fib and F1+2 at T4 were significantly increased, while the AT-IE activity at T3 was significantly decreased in group Ⅲ(P＜0.05) .Conclusion When the duration of pneumoperitoneum is short, no obvious changes in the blood coagulation, fibrinolysis and endothelial damage are observed postoperatively in patients undergoing laparoscopic cholecystectomy, and along with the prolongation of the duration of pneumoperitoneum, increased blood coagulation, reduced fibrinolysisand aggravated endothelial damage are observed postoperatively.
Résumé
Objective To explore the feasibility of using unilateral continuous spinal anesthesia(UCSA)with hypobaric levobupivacaine in elderly patients undergoing hip replacement.Methods Sixty ASAⅠ~Ⅲ patients aged 63~91 were randomized to one of two groups:group U unilateral continuous spinal anesthesia(UCSA)(n=30)and group S single spinal epidural anesthesia(SSEA)(n=30).Patients in group U were performed at L2,3 or L3,4 interspace with the patients in the lateral position with the diseased leg upper most.The patients received a continuous spinal catheter,Hypobaric 0.375% levobupinacaine solution 0.5～1.0ml was injected.If analgesia did not reach T10 after 5～10min the same dose was repeated.Patients in group S were performed at L2,3 or L3,4 interspace with the patients in the lateral position with the diseased leg down most.Hyperbaric 0.375% bupivacaine solution 3 ml was injected into subarach noid through spinal needle,which was threaded through epidural needle.Then epidural catheter was placed.The position was adjusted to the analgesia level to reach T10.Parameters of circulation and respiration function were recorded.The level of block and degree of motor blockade were measured and recorded.The intraoperative and postoperative complication associated with spinal or epidural anesthesia were recorded.Results MAP was slightly decreased after initial dose of local anesthetics as compared to the baseline MAP in both groups.The incidences of hypotension was significantly lower in group U than in group S.There was no significant decreasement in SpO2 and no significant change in HR during operation in both groups.There was lower sensory block in group U than in group S.There was no significant difference in degree of motor blockade,dose of innovar,incidences of tremble,nausea and vomiting,headache and neural complication after operation between the two groups.Conclusion Both UCSA and SSEA can produce satisfactory sensory block for hip replacement.But UCSA can produce stabler hemodynamics and is anesthesia method of choice in elderly patients undergoing hip replacement.
Résumé
Objective To observe the preventive effect of granisetron on postoperative nausea and vomiting(PONV) after laparoscopic cholecystectomy(LC).Methods A total of 120 ASAⅠ~Ⅱ patients undergoing LC were randomly divided into(3 groups) with 40 patients in each group.After operation,the Group A was given an intravenous injection of 3 mg granisetron,the Group B received 6 mg granisetron,and the Group C received 6 ml normal saline.The incidence of nausea,vomiting,headache,and dizziness of the 3 groups at 0~4 h,4~8 h,8~24 h,and 24~48 h after operation was observed.Results The incidence of PONV in the Group A and B was significantly lower than that in the Group C(P
Résumé
Objective To compare the expression of pancreatic triglyceride lipase in type-1(T1A) and type-2 astrocytes(T2A).Methods Purified cultures of cortical T1A and T2A were prepared from neonatal rats.The expression of pancreatic triglyceride lipase mRNA was detected by reverse transcriptase polymerase chain reaction(RT-PCR).And the protein level was determined by immunocytochemistry with laser scanning confocal microscope.Results RT-PCR showed that the expression of pancreatic triglyceride lipase mRNA was negative in T1A and positive at a high level in T2A.Immunocytochemistry demonstrated that pancreatic triglyceride lipase expressed at a low level in T1A and was mainly distributed in the nuclei.By contrast,pancreatic triglyceride lipase expressed at a high level in T2A and was distributed diffusedly in the cytoplasm,nuclei and processes.Conclusion T1A and T2A showed different expression levels of pancreatic triglyceride lipase. Pancreatic triglyceride lipase expressed at a high level in T2A,which indicated that T2A may play an important role in the metabolism of lipids in the central nervous system.