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Endocrine disrupting chemicals (EDCs) are a class of chemical substances widely present in daily-life environment, and can enter human body through various pathways, posing a threat to reproductive development and health. Oxidative stress (OS) is one of the most important fundamental mechanisms underlying the reproductive toxicity of EDCs. Numerous studies have found that exposure to EDCs can increase the levels of reactive oxygen species (ROS) in human reproductive system and reduce the activity and quantity of multiple enzymatic antioxidants, leading to oxidative stress and inducing damage to the reproductive system at various levels such as DNA and cells. Many research results have shown that supplementing food-derived non-enzymatic antioxidants can reduce ROS levels and increase the activity of enzymatic antioxidants, thereby reduce OS levels, and further repair EDCs-induced reproductive damage. In addition, many food-derived antioxidants are important elements involved in reproductive physiological activities and have protective effects on reproductive health. This paper summarized the reproductive toxicity of EDCs, including damage to reproductive cells, interference with hormone action, and influence on reproductive-related epigenetic regulation, elaborated the relationship between OS and reproductive toxicity of EDCs, and further summarized the alleviating effects and related mechanisms of food-derived antioxidants such as vitamins, trace elements, and plant polyphenols and pigments against reproductive toxicity of EDCs, aiming to provide a theoretical and scientific basis for prevention and treatment against reproductive toxicity of EDCs.
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Objective:To evaluate the safety and efficacy of drug-coated balloon (DCB) in the treatment of symptomatic intracranial atherosclerotic stenosis.Methods:Forty-nine patients with symptomatic intracranial atherosclerotic stenosis treated with DCB in the People′s Hospital of Zhengzhou University from January 2018 to August 2021 were retrospectively included. The location and number of lesions were as follows: 21 cases of the middle cerebral artery, 11 cases of the intracranial segment of vertebral artery, 12 cases of the basilar artery, and 5 cases of the intracranial segment of internal carotid artery. Pre-dilatation of the lesion with a normal balloon followed by DCB angioplasty. Clinical follow-up (outpatient or telephone) was carried out at 30 days, 3 months, 6 months, and 1 year after the operation. Imaging follow-up was carried out at 6 months postoperatively. The surgical success rate (defined as the proportion of patients with residual stenosis<50% after balloon dilatation), perioperative safety (any strokes, TIA, and deaths within 1 month), stroke recurrence, and restenosis were analyzed.Results:The operation was performed in all patients successfully. The median stenosis level was 80% (75%, 85%) preoperatively and 20% (15%, 30%) at the time after the operation. The success rate of the operation was 91.8% (45/49). Stenting was given in 11 cases (22.4%, 11/49) for severe flow-limiting vascular entrapment, or non-flow-limiting entrapment, owing to the concern of subsequent progression of the entrapment. Three cases (6.1%, 3/49) had significant vascular elastic retraction and implement stent implantation. One patient (2.0%, 1/49) developed symptomatic cerebral infarction during perioperative period, and the symptoms improved after treatment. No fatal or disabling stroke occurred. All patients were followed-up successfully. The median follow-up time was 12 months. Two patients (4.1%, 2/49) had a stroke in the responsible vascular area, and 1 (2.0%, 1/49) patient had a stroke in the non-responsible vascular area. Thirty-eight patients (77.6%, 38/49) had followed-up images. The median follow-up time of postoperative imaging was 6 months. Restenosis occurred in two cases (1 case had symptomatic restenosis), and the incidence of restenosis was 5.3% (2/38).Conclusions:DCB in the treatment of symptomatic intracranial atherosclerotic stenosis has a high technical success rate, good perioperative safety, and low stroke recurrence rate in short-term follow-up, demonstrating the good feasibility, safety, and efficacy of DCB.
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Objective:Based on single-center clinical results of endovascular recanalization for symptomatic non-acute internal carotid artery occlusion (ICAO), a new patient classification method is proposed to distinguish the most suitable ICAO patient subgroups for endovascular recanalization.Methods:A total of 140 patients with symptomatic non-acute ICAO accepted endovascular recanalization in Department of Cerebrovascular Intervention, He'nan Provincial People's Hospital from January 2019 to December 2021 were selected. These patients were divided into low risk group ( n=57), medium risk group ( n=54) and high risk group ( n=29) according to the occlusion segments, occlusion times, plaque features, calcification at the occlusion site and occlusion segment angulation. The immediate postoperative recanalization rate, perioperative complications, perioperative death, and prognoses 90 d after endovascular recanalization (modified Rankin scale scores of 0-2 as good prognosis) were evaluated in the 3 groups. Results:The immediate postoperative recanalization rate was 82.9% (114/140), perioperative complication rate was 11.4% (16/140), and perioperative mortality was 0.7% (1/140). The success recanalization rate decreased gradually from the low risk group to the high risk group (100%, 85.2%, and 37.9%), while the perioperative complication rate was the opposite (0%, 11.1%, and 34.5%), with significant differences ( P<0.05). Ninety d after endovascular recanalization, 109 patients had good prognosis and 27 had poor prognosis; the good prognosis rate in low risk group, medium risk group and high risk group was 98.2%, 79.6% and 34.5%, respectively, with significant differences ( P<0.05). The vascular restenosis rate in low risk group, medium risk group and high risk group was 0%, 8.7% and 18.2%, and re-occlusion rate was 0%, 6.5% and 27.2%, respectively, 90 d after endovascular recanalization, with significant differences ( P<0.05). Conclusion:Endovascular recanalization is technically feasible for patients with symptomatic non-acute ICAO, especially those met the criterions of low and medium risk groups in our study.
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Objective:To evaluate the safety, feasibility and efficacy of drug-coated balloon (DCB) in the treatment of in-stent restenosis (ISR) of the vertebrobasilar artery.Methods:Twenty-one patients with ISR of the vertebrobasilar artery treated with DCB at the Zhengzhou University People′s Hospital from January 2018 to December 2020 were retrospectively included. There were 22 lesions with ISR, of which 8 were located in the initial segments of vertebral artery, 12 were located in the V4 segment of the vertebral artery, and 2 were located in the basilar artery. The clinical prognosis was evaluated by modified Rankin Scale (mRS), and the target vessel restenosis was evaluated by DSA, CTA or MRA. The safety, feasibility and effectiveness of DCB in the treatment of vertebrobasilar artery ISR were analyzed by perioperative complications, technical success rate and follow-up.Results:All 21 patients with ISR underwent successful interventional surgery. No stroke, TIA and death occurred in perioperative period. During the operation, two cases (9.5%) were treated with Apollo stent due to the residual stenosis>50% after DCB dilation. The technical success rate was 90.5%. The mean stenosis of the target vessel was improved immediately from preoperative (78.1±11.3)% to postoperative (22.1±8.3)%. All the 21 patients were followed up. As of the last follow-up in September 2021, the median clinical follow-up period was 19 (12, 33.5) months, and there were no stroke, TIA and death caused by the corresponding artery. The mRS score was 0 in 18 patients 1 in 2 patients and 2 in 1 patient. Imaging follow-up was available in 13 cases (61.9%) with a median follow-up time of 7(5.5, 19) months, and the target vessel restenosis rate was 7.7% (1/13).Conclusions:This preliminary study has shown that DCB in the treatment of ISR of the vertebrobasilar artery is safe and feasible, with a high technical success rate and low restenosis rate, which provides clinical application evidence, but the long-term effect needs further follow-up observation.
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Objective:To explore the countermeasures to strengthen hospital scientific research management and prevent research misconduct by studying the characteristics of research misconduct cases investigated by the NSFC in recent three years.Methods:Information of a total number of 67 research misconduct cases in 6 batches that publicly reported by the NSFC from 2019 to 2021 were collected, classified statistics were conducted on the situation of the supporting units involved, the specific issues of Misconduct and the disciplinary measures of the NSFC. According to the frequency proportion of misconduct problems, the tendency characteristics and reasons were analyzed and summarized, countermeasures and suggestions were put forward.Results:96.36% of the main responsibility entity of research misconduct was individuals, and 3.63% of the main responsibility of relying institution. There were 62 cases of research misconduct due to scientific papers and applications, accounted for 92.50%. Among the problematic papers involved, data fraud accounted for 48.20%, false signature or unauthorized signature accounted for 35.97%, plagiarism accounted for 32.37%, and unauthorized marking of other people′s fund number accounted for 27.33%. The NSFC revoked 55 fund projects involved and recovered funds, 67 people were disqualified from applying for projects with a maximum of 7 years and a minimum of 2 years, and 2 peer-review experts were punished.Conclusion:Hospital scientific research management should draw lessons from others, and put forward specific countermeasures from the aspects of strengthening scientific research integrity education, improving the construction of supervision mechanism, strictly implementing process management and perfecting scientific research credit evaluation system, in order to provide possible reference for preventing misconduct in hospital scientific research management practice.
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Objective:To investigate the safety and effectiveness of Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.Methods:A retrospective analysis was performed. Six patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection admitted to the 3 hospitals from May 2016 to December 2019 were chosen; their clinical data were collected. The surgical processes and complications were concluded, and the prognoses were evaluated by modified Rankin scale (mRS).Results:One patient was treated with intraoperative simple tamponade compression for hemostasis, and died for massive intracranial hemorrhage 2 weeks after surgery. Five patients were occluded by Willis covered stents; the occluded success rate was 100% but ophthalmic arteries were blocked in all. During the perioperative period, diabetes insipidus occurred in one patient and incomplete oculomotor paralysis occurred in one patient; 5 patients were followed up for 3-12 months: MRI indicated subtotal resection of tumor in 4 patients and total resection in one patient, no new bleeding or ischemic stroke events occurred in these 5 patients, and the prognosis was good.Conclusion:Willis covered stent is safe and effective in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.
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Objective:To investigate the morphological and hemodynamic stress characteristics of infundibular dilatation of the posterior communicating artery.Methods:From January 2018 to May 2020, 30 patients with infundibular dilatation of the posterior communicating artery (observation group) found by digital substraction angiography (DSA) for suspecting as having equivocal posterior communicating artery aneurysm in our hospital were selected. The angle between posterior communicating artery and internal carotid artery, and hemodynamics stress parameters at the infundibular dilatation of the posterior communicating artery (total pressure and shear force) were measured by DSA and quantitatively analyzed by computational fluid dynamics methods. Thirty patients without intracranial aneurysm and with normal posterior communicating arteries admitted to our hospital at the same period were used as control group.Results:The mean value of the bending angle between the posterior communicating artery and internal carotid artery in the control group was ([80.1±8.4]°), which was significantly higher than that in the observation group ([73.2±5.8]°, P<0.05). The shear force and total pressure of infundibular dilatation of the posterior communicating artery of the observation group ([8.32±0.70] Pa and [85.61±6.04] Pa), which were significantly higher than those of the control group at the same locations ([3.95±0.28] Pa and [25.72±7.18] Pa, P<0.05). Conclusion:There are significant differences in hemodynamic stress between the normal posterior communicating artery and the infundibular dilatation of the posterior communicating artery, which might play an important role in triggering the formation of aneurysms.
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Objective:To investigate the effect of thrombus burden on the clinical outcome of endovascular recanalization in large vessel occlusive stroke.Methods:Patients with acute anterior circulation occlusion who underwent endovascular treatment within 24 hours after onset in Zhengzhou University People′s Hospital from January 2018 to December 2019 were retrospectively collected. According to the clot burden score (CBS) of DSA, total objectives were divided into CBS≥6 group (24 cases) and CBS<6 group (38 cases). Clinical data of the two groups were collected and the modified Rankin scale (mRS) was used to evaluate the clinical outcome at 90 days after surgery. Independent sample t-test, Wilcoxon rank sum test and χ 2 test were used to compare the clinical data between the two groups. Independent risk factors affecting the clinical outcome were analyzed by binary logistic regression. Results:There were no statistically significant differences in basic demographic data, stroke risk factors and other factors between the CBS≥6 group and CBS<6 group ( P>0.05).The proportion of using tirofiban after surgery in the CBS≥6 group (63.2%, 24/38) was lower than that in the CBS<6 group (87.5%, 21/24) (χ2=4.380, P=0.044). The discharge NIHSS score of the CBS≥6 group was [5.0 (3.3, 7.8) points] lower than CBS<6 group [8.5 (1.8, 14.5) points] ( Z=5.221, P=0.022). The proportion of postoperative mRS 0-2 was (91.7%, 22/24) in the CBS≥6 group higher than CBS<6 group(39.5%, 15/38) (χ2=20.486, P=0.001), there were no statistically significant differences between the two groups ( P<0.05). The results of binary logistics regression analysis showed the CBS groups (OR=0.042, 95%CI 0.007-0.244 , P=0.001) was an independent risk factor affecting good outcome. Subgroup analysis of whether tirofiban was used or not showed there was no statistically significant difference in clinical prognosis between the two groups ( P>0.05). Conclusions:The clinical outcome of CBS≥6 group is significantly better than that of CBS<6 group, and patients with small thrombus burden are more likely to get a good clinical outcome of 90 days.
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Objective:To evaluate the value of endovascular recanalization and hybrid recanalization for chronic internal carotid artery occlusion(COICA), and to evaluate its feasibility, safety, success rate, and clinical outcomes.Methods:Totally 35 patients who received endovascular recanalization or hybrid recanalization with symptomatic COICA were enrolled from January 2019 to December 2019 in Department of Cerebrovascular Disease,Zhengzhou University People′s Hospital. The clinical characteristics, treatment strategies, success rate, and major events of the patients were analyzed retrospectively.Results:Thirty of 35 patients were successfully recanalized. Among them, hybrid recanalization was performed in 3 cases, carotid endarterectomy was performed in 1 case, and endovascular recanalization was performed in 26 cases, 5 patients failed because they could not reach the distal true cavity. Among the successful patients, 5 patients had operation-related complications, 3 patients had embolism cerebral infarction, 1 patient had hyperperfusion cerebral hemorrhage, 1 patient still had transient ischemic attack after operation. All patients were followed up clinically, 2 patients had reoccurrence of obstruction, 2 patient had restenosis, the remaining patients had no hemodynamic stenosis or reocclusion.Conclusion:In highly-selected cases, intracavitary recanalization for symptomatic COICA is feasible, relatively safe and effective.
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Objective To investigate the safety,efficacy and feasibility of endovascular recanalization in non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery,and analyze the factors affecting its success.Methods Fifty-four patients with non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery,underwent endovascular recanalization in our hospital from January 2013 to December 2017,were enrolled.Modified Rankin scale (mRS) and National institutes of health stroke scale (NIHSS) scores were compared before and after treatment;the prognosis results were analyzed after 2 years of follow-up.Independent factors influencing the prognoses were identified by Logistic regression analysis.Results Recanalization was achieved in 52 patients and failure was noted in two patients.The mRS scores and NIHSS scores before treatment (2.25±0.13,18.43±1.36) were significantly higher than those after treatment (1.44±0.05,11.81±0.71,P＜0.05).After 2 years of follow-up,good prognosis was noted in 42 patients,poor prognosis in 8 patients,and loss of follow-up in 2 patients.Multivariate Logistic analysis showed that history of hypertension and history of diabetes were independent risk factors for the prognoses of patients with non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery after endovascular reeanalization (OR=1.429,95CI:1.146-1.783,P=0.005;OR=2.597,95CI:2.364-2.854,P=0.005).Conclusion The curative effect of interventional therapy for non-acute occlusion of symptomatic internal carotid artery is reliable,and histories of hypertension and diabetes can affect the prognoses of patients.
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Objective:To investigate the safety and efficacy of endovascular treatment in acute anterior circulation massive cerebral infarction and its prognostic factors.Methods:A retrospective analysis was performed on clinical data of 34 patients with acute anterior circulatory massive cerebral infarction who received intravascular treatment in our hospital from February 2018 to December 2019. The perioperative hemorrhage rate and mortality rate were analyzed in these patients. Modified Rankin scale (mRS) scores were taken as the evaluation standard in the prognoses of these patients during the 90 d of follow up, and the influencing factors affecting the prognoses of patients with massive cerebral infarction were analyzed.Results:The operation was successful in 30 patients (88.2%); the operation time was (97.41±54.58) min, and the number of thrombolysis was (1.91±0.75) times. Distal embolization occurred in 4 patients (11.8%); there were 3 patients with non-symptomatic hemorrhage (8.8%) and 3 patients with symptomatic hemorrhage (8.8%). Cerebral hernia occurred in 7 patients (20.6%); there were 5 deaths (14.4%). During the 90 d of follow up, 13 patients (38.2%) had good prognosis, and 21 (61.8%) had poor prognosis; there were statistically significant differences in NIHSS scores at admission, infarction locations in diffusion weighted imaging, vascular occlusion locations in DSA, pecentages of patients accepted preoperative intravenous thrombolysis and patients with cerebral hernia between the two groups ( P<0.05). NIHSS scores at admission ( OR=0.817, 95% CI: 0.682-0.980, P=0.029), thrombus load scale scores ( OR=5.981, 95%CI: 1.827-19.575, P=0.003), vascular occlusion locations in DSA ( OR=0.031, 95% CI: 0.003-0.311, P=0.003) and pecentage of patients accepted preoperative intravenous thrombolysis ( OR=0.092, 95% CI: 0.010-0.838, P=0.034) were independent factors influencing the prognoses of emergency intravascular treatment. Conclusions:Endovascular recanalization can achieve a relatively good prognosis in patients with massive cerebral infarction. Patients with low NIHSS scores, high thrombotic load scale scores, and middle cerebral artery occlusion, and patients accepted direct intravascular treatment have relatively good prognosis.
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Objective To investigate the clinical prognoses of acute vertebral basilar artery occlusion by endovascular treatment and the risk factors for poor prognosis. Methods Clinical data of 43 patients with acute vertebral basilar artery occlusion who underwent endovascular treatment in our hospital from August 2016 to December 2017 were retrospectively analyzed. The immediate revascularization rate and clinical outcomes three months after surgery were analyzed; and according to the clinical prognoses, these patients were divided into a good prognosis group and a poor prognosis group. Receiver operating characteristic (ROC) curve was used to compare the NIHSS scores, times from onset to vessel recanalization, improved post-circulation CT scale of Alberta stroke project based on diffusion weighted imaging (DWI-PC-ASPECTS) scores, and MR angiography-basilar artery on computed tomography angiography prognostic scalere for basilar artery occlusion (MRA-BATMAN) scores to predict the prognoses. Univariate Logistic regression analysis and multivariate Logistic regression analysis were used to evaluate the relations of times from onset to vessel recanalization, NIHSS scores, DWI-PC-ASPECTS scores, and MRA-BATMAN scores with poor prognosis. Results Forty-three patients (100％) achieved thrombolysis in cerebral infarction (TICI) grading 3/2b immediately after surgery. The mRS scores were 0-2 in 26 patients (60.5％, good prognosis group), and those were 3-6 in 17 patients (39.5％, poor prognosis group) three months after surgery. When the NIHSS scores was 21, times from onset to vessel recanalization was 600 min, DWI-PC-ASPECTS predictive threshold was 8.5 and MRA-BATMAN predictive threshold was 6.5, the diagnostic accuracy of predicting poor prognosis was the highest (sensitivity=0.941, 0.706, 0.808, and 0.577, and specificity=0.846, 0.423, 0.647, and 0.824). Univariate Logistic regression analysis showed that preoperative NIHSS scores≥21, improved DWI-PC-ASPECTS scores≤8.5, and MRA-BATMAN scores≤6.5 were risk factors for poor prognosis (P<0.05). Multivariate Logistic regression analysis showed that preoperative NIHSS scores≥21 was an independent risk factor for poor prognosis (OR=15.679, 95％CI:1.608-152.879, P=0.000). Conclusion Intravascular treatment of acute vertebral basilar artery occlusion is safe and effective, and the patients with preoperative NIHSS scores≥ 21 are highly likely to have poor prognosis.
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Objective To investigate the efficacy and safety of a direct aspiration first-pass thrombectomy (ADAPT) technique in treating acute atherosclerotic intracranial large vessel occlusion. MethodsSeventy-two patients with acute atherosclerotic intracranial large vessel occlusion underwent endovascular treatment in our hospital from March 2018 to March 2019 were chosen in our study; ADAPT technique was used in 24 patients, and Solitaire stent combined with penumbra suction catheter extraction (Solumbra) technique was used in 48 patients. Remedial measures were adopted after the failure of recanalization. Modified intraoperative cerebral infarction thrombolysis grading was used for vascular recanalization evaluation. The prognoses of the patients were determined according to modified Rankin scale (mRS) scores 3 months after operation, and the efficacy and safety of the patients in the two groups were compared.ResultsAs compared with patients in the Solumbra group, patients in the ADAPT group had statistically shorter time from femoral artery puncture to reflow (P<0.05). The first-time recanalization rates of patients in Solumbra group and ADAPT group were 25.0％ and 16.67％, without statistically significant difference (P>0.05). The final recanalization rates of patients in Solumbra group and ADAPT group were 83.33％ and 75.00％, without statistically significant difference (P>0.05). There was no significant difference in proportion of patients with good prognosis, incidence of perioperative symptomatic intracranial hemorrhage and mortality between the two groups (P>0.05). ConclusionFor patients with acute atherosclerotic intracranial large vessel occlusion, endovascular treatment with ADAPT technique is comparable with Solumbra technique.
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Objective To investigate the safety of endovascular thrombectomy in acute ischemic stroke patients with pre-existing intracranial aneurysms. Methods Seven patients with acute ischemic stroke combined with intracranial aneurysms, admitted to and received endovascular treatment in our hospital from January 2014 to December 2016, were chosen. The clinical data and safety were analyzed retrospectively. Results All patients with pre-existing intracranial aneurysms suffered acute large artery occlusion achieved successful endovascular re-canalization, and one patient suffered subarachnoid hemorrhage due to the rupture of aneurysm during the procedure. Three patients had grading 2b of Thrombolysis in Cerebral Infarction (TICI), and 4 had grading 3 of TICI. Four patients had 0-2 scores of modified Rankin Scale (mRS), one had 3 scores, and two died. Conclusion Endovascular thrombectomy in acute ischemic stroke patients with pre-existing intracranial aneurysms is safe.
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Objective To investigate the effect of maintenance hemodialysis on regulatory T cells (Treg) and helper T cells (Th17) in uremic patients.Methods One hundred and eighty-five patients with uremia from February 2014 to February 2017 in our hospital were selected,including 102 cases of hemodialysis as the dialysis group and 83 cases without conducting hemodialysis as the non-dialysis group.Contemporaneous 100 healthy volunteers were selected as the control group.The levels of Treg,Th17,interleukin-6 (IL-6),IL-10 and IL-17 were detected in each group.Results The levels of Treg,Th17,IL-6 and IL-17 in the control group were significantly lower than those in the non-dialysis group and dialysis group (P＜0.05),while the level of IL-10 was significantly higher than that in the non-dialysis group and dialysis group (P＜0.05);the levels of Treg,Th17,IL-6 and IL-17 in the dialysis group were (5.02±1.80)％,(20.16±7.04)％,(28.78± 4.18) pg/mL and (40.38±9.03) pg/mL,which were significantly lower than those in the non-dialysis group (P＜0.05),and the IL-10 level in the dialysis group was (18.52±2.19) pg/ml,which was significantly higher than that in the non-dialysis group (P＜0.05).Conclusion The imbalance of Treg and Th17 levels exist in uremic patients,and hemodialysis can help to improve the imbalance of Treg and Th17 levels.
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Background and purpose: Epithelial ovarian carcinoma is the most malignant tumor in female reproductive system because of its resistance to chemotherapy. Fructose-1, 6-bisphosphatase (FBP1) is a rate-limiting enzyme in gluconeogenesis used to catalyze the hydrolysis of fructose-1, 6-bisphosphate to fructose-6-phosphate and inorganic phosphate, thereby inhibiting the effect of glycolysis in tumor cells. This study aimed to investigate the association between the expression of FBP1 and chemosensitivity. Methods: The expression level of FBP1 in ovarian cancer patients was measured by immunohistochemistry. Results: According to the results of immunohistochemistry in 209 ovarian carcinoma specimens, the percentage of positive FBP1 expression was about 49.3% (103/209). Loss of FBP1 was a negative factor of survival (42.6 months vs 62.1 months, P=0.003). Besides, patients who were sensitive to chemotherapy displayed significantly higher scores of FBP1 expression than patients who were resistant to therapy (P=0.007). Conclusion: The rate-limiting enzyme FBP1 in gluconeogenesis can be used as a biomarker for predicting the chemoresistance and prognosis of ovarian cancer patients.
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One hundred and forty-two patients on maintenance hemodialysis were enrolled in the study.According to the guideline of American Society of Echocardiography 97 patients (68.3％) were classified as pulmonary artery hypertension [PAH,pulmonary artery systolic pressure (PASP) ＞ 35 mmHg (1 mmHg =0.133 kPa)] and 45 patients (31.7％) as non-PAH (PASP ≤ 35 mmHg).High sensitivity Creactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α) were measured by automatic analyzer and enzyme linked immunosorbent assay (ELISA),respectively.There were significant differences in CRP and TNF-α levels between PAH and non-PAH patients (P ＜ 0.05).Multivariate linear regression showed that TNF-α and interdialytic weight gain were positively correlated with PAH and left ventricular ejection fraction was negatively correlated with PAH (P ＜ 0.01).In the multivariate Cox proportional hazards models,PAH and TNF-α level were independently associated with higher risk for all-cause death (HR =1.06,95％ CI:1.03-1.09 and HR =1.31,95％ CI:1.17-1.46,respectively).In Kaplan-Meier survival analysis,the risk of all-cause mortality increased in parallel with PASP.The risk of death in patients with PASP ＞45 mmHg was higher than that in patients with PASP ≤45 mmHg (log-rank test:x2 =6.58,P =0.010),the risk was 2.82-fold (HR =2.82,95％ CI:1.38-5.77,P =0.004).
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Objective To discuss the application value,safety and feasibility of indwelling guidewire technique in performing mechanical thrombectomy for acute cerebral artery occlusion.Methods The clinical data of 15 patients with acute ischemic stroke,who were treated with mechanical thromnectomy at authors' hospital during the period from December 2015 to February 2016,were retrospectively analyzed.The diseases included middle cerebral artery occlusion (n=6),internal carotid artery and middle cerebral artery occlusion (n=5) and vertebral basilar artery occlusion (n=4).Indwelling guide-wire technique was adopted to quickly and accurately determine the vascular occlusion characteristics,then,endovascular mechanical thrombectomy was carried out.Results By using indwelling guide-wire technique,the occlusive features of the diseased arteries were successfully and precisely determined.Immediate recanalization of the occluded artery was obtained in 13 patients (87％).The blood flow classification score after thrombolysis in cerebral infarction (TICI) reached 3 points in 10 patients and 2b points in 5 patients.In 2 patients,the vascular recanalization procedure failed because the thrombus load was large,the length of occluded segment was long,and the effect of mechanical thromnectomy was poor.According to American National Institutes of Health Stroke Scale (NIHSS),the evaluation score was improved from preoperative (19.2±7.0) to postoperative (6.3±3.6),the difference was statistically significant (P＜0.05).Three months after the treatment,the score measured by modified Rankin scale(mRS) was ≤2 points in 10 patients.Conclusion Mechanical thrombectomy is safe and effective for the treatment of acute cerebral artery occlusion.The indwelling guide-wire technique can safely,conveniently,quickly and accurately determine the characteristics of the occluded blood vessels,which is very helpful in assisting surgical manipulation,reducing procedure-related complications,and improving vascular recanalization rate.(J Intervent Radiol,2017,26:202-205)
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Objective To evaluate the mid-and long-term follow-up outcome of revascularization and stenting of nonacute intracranial vertebrobasilar artery occlusion. Methods Consecutive data of 27 patients who suffered from nonacute intracranial vertebrobasilar artery occlusion beyond 24 hours and underwent endovascular revascularization, were retrospectively collected and analyzed. Complications and recurrent ischemic events during the follow-up period were recorded. The modified Rankin scale(mRS) scores were used and compared between pre-and postoperation. Results All 27 patients except one(96.3%) obtained successful recanalization. After the procedure, 13 patients showed improvement, 11 were stable, and 3 worse. The decline of median mRS scores, which was 4(interquarter range-IR, 2-5) preoperatively and 3(IR, 1-5) on discharge. Five patients suffered from procedural complications and three of them resulted in aggravation. Nineteen patients received imaging follow-up during the median 10 months, 6 restenosis occurred and 3 of them were symptomatic. During median 55 months clinical follow-up after operation, 2 ipsilateral stroke and 2 ipsilateral transient ischemic attack occurred. The mRS scores decreased significantly in the first one year after procedure. Conclusions Revascularization and stenting of nonacute intracranial vertebrobasilar artery occlusion can prevent recurrent ipsilateral ischemic event and improve disability recovery in the first one year.
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Objective To evaluate the safety and efficacy of stent implantation used as a rescue measure for acute ischemic stroke.Methods The clinical data of 13 patients with acute ischemic stroke caused by large artery occlusion of anterior c erebral circulation that occurred within 8 hours before clinical visit,who had received rescue stent implantation at authors' hospital,were retrospectively analyzed.Before stent implantation,all patients failed to respond to other recanalization treatments,including intravenous thrombolysis,intra-arterial thrombolysis,mechanical thrombec tomy with Penumbra device,and Solitaire stent thrombectomy.Angiography was performed immediately after stent implantation.Vascular recanalization condition was evaluated with blood flow grading that was based on thrombolysis in cerebral infarction (TICI) criterion.Perioperative bleeding and complications were recorded.National Institutes of Health Stroke Scale (NIHSS) score was used to assess the improvement of neurological function at one week after operation.Modified Rankin scale (mRS) score was used to evaluate the prognosis at 3 months after operation.Results A total of 16 stents were implanted in 13 patients.Before stent implantation,thrombectomy by using Solitaire retrievable stent was employed in 10 patients,mechanical thrombectomy with Penumbra device was adopted in 3 patients,intravenous thrombolysis with urokinase was used in one patient,and intra-arterial thrombolysis with urokinase was conducted in one patient.After stent implantation,partial or complete recanalization was achieved in 12 patients (TICI≥2b/3).NIHSS score was improved from preoperative (16.15±5.81) points to postoperative (8.08±5.61) points,the difference was statistically significant (P＜0.05).Three months after stenting treatment,good prognosis (mRS ≤2) was obtained in 7 patients (53.8％) and 2 patients died.Intracranial hemorrhage occurred in 2 patients and procedure-related embolism was observed in 3 patients.Conclusion For the treatment of acute ischemic stroke,intracranial stenting angioplasty,used as a rescue measure for thrombolytic therapy with different combinations of drugs,is safe and effective.