Variation rules of main secondary metabolites in Hedysari Radix before and after rubbing strip / 中成药

AIM To investigate the variation rules of main secondary metabolites in Hedysari Radix before and after rubbing strip.METHODS UPLC-MS/MS was adopted in the content determination of formononetin,ononin,calycosin,calycosin-7-glucoside,medicarpin,genistein,luteolin,liquiritigenin,isoliquiritigenin,vanillic acid,ferulic acid,γ-aminobutyric acid,adenosine and betaine,after which cluster analysis,principal component analysis and orthogonal partial least squares discriminant analysis were used for chemical pattern recognition to explore differential components.RESULTS After rubbing strip,formononetin,calycosin,liquiritigenin and γ-aminobutynic acid demonstrated increased contents,along with decreased contents of ononin,calycosin-7-glucoside and vanillic acid.The samples with and without rubbing strip were clustered into two types,calycosin-7-glucoside,formononetin,γ-aminobutynic acid,vanillic acid,calycosin-7-glucoside and formononetin were differential components.CONCLUSION This experiment clarifies the differences of chemical constituents in Hedysari Radix before and after rubbing strip,which can provide a reference for the research on rubbing strip mechanism of other medicinal materials.

Predictive value of D-dimer for futile recanalization after mechanical thrombectomy in patients with acute ischemic stroke / 中华全科医师杂志

Objective:To investigate the predictive value of preoperative D-dimer level for futile recanalization (FR) after mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS).Methods:It was a nested case-control study. A total of 116 patients with large vessel occlusion (LVO) stroke, who underwent successful recanalization (modified Thrombolysis in Cerebral Infarction, mTICI≥2b) after MT at the Stroke Unit of Beijing Hospital from August 2018 to January 2022,were consecutively enrolled, including 72 males (62.1%) with the age of (72.8±13.1) years. According to the 3-month modified Rankin Scale (mRS) score after MT, patients were divided into the meaningful recanalization group (mRS 0-2, n=41) and the futile recanalization group (mRS 3-6, n=75). The baseline clinical data of enrolled patients was collected. Logistic regression analysis was used to identify the independent risk factors for FR after MT in patients with AIS. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of D-dimer for FR. Results:Multivariate logistic regression analysis showed that high baseline systolic blood pressure (SBP) ( OR=1.038, 95% CI: 1.012-1.065, P=0.004), baseline National Institutes of Health Stroke Scale (NIHSS) score≥12 ( OR=10.157, 95% CI: 3.624-28.470, P<0.001) and high preoperative D-dimer level ( OR=4.536, 95% CI: 1.379-14.922, P=0.013) were independent predictors of FR after MT in AIS patients with LVO. ROC curve analysis indicated a good predictive value of preoperative D-dimer for the occurrence of FR ( AUC=0.733, 95% CI: 0.638-0.829, P<0.05), the optimal cut-off value of D-dimer was 2.65 μg/L(Lg), with the Youden index, sensitivity, specificity and accuracy of 0.435, 53.3%, 90.2% and 66.4%, respectively. Conclusion:High preoperative D-dimer level is an independent predictor of futile recanalization after MT in AIS patients with LVO, which shows good predictive ability for futile recanalization.

Exploration the Immune Regulatory Mechanism of Hedysari Radix Based on Network Pharmacology,Molecular Dynamics,and UPLC-MS/MS / 中药新药与临床药理

Objective To predict the core targets and action pathways of Hedysari Radix based on UPLC-MS/MS and network pharmacology methods,and to verify the results of network pharmacology by molecular docking and molecular dynamics techniques.This article aims to investigate immune regulation mechanism of effective components absorbed into blood from Hedysari Radix.Methods Qualitative quantification of effective components absorbed into blood from Hedysari Radix were operated by using UPLC-MS/MS technique.The corresponding targets of effective components absorbed into blood from Hedysari Radix were screened by TCMSP and HERB databases.Targets of immune-related disease were obtained through DisGeNET,OMIM,TTD,and MalaCards databases.The network of"components absorbed into blood from Hedysari Radix-immune-related diseases"was then constructed.GO and KEGG enrichment analysis and mapped the PPI network were performed.Molecular docking and molecular dynamics techniques were applied for validation.Results A total of 8 prototype components absorbed into blood,synergistically acting on 101 targets,were identified by UPLC-MS/MS.They mediated 538 biological processes including immune response,positive regulation of gene expression,receptor binding,and cytokine activity.Meanuhile,116 signaling pathways,such as HIF-1,Toll-like receptor,JAK-STAT,T cell receptor,PI3K-Akt,and FoxO etc.were involved.The core targets were MAPK14,PTGS2,MMP9,PPARG,CCND1,etc..The results of molecular docking showed that formononetin and calycosin had strong docking binding activity with MAPK14.And molecular dynamics simulations further demonstrated that the binding between MAPK14 and formononetin or calycosin had good structural stability and binding affinity.Conclusion The results of serum pharmacochemistry,network pharmacology and molecular dynamics were verified to reveal the material basis and mechanism of Hedysari Radix in regulating immunity.The aim of this study is to provide scientific basis for its immunomodulatory mechanism.

Current Status and Progress of Diagnostic Techniques for Cancer of Unknown Primary / 肿瘤防治研究

Cancer of unknown primary (CUP) is a heterogeneous tumor type that has been diagnosed as a metastatic tumor by pathological examination, but the primary tumor cannot be identified through comprehensive clinical examination. The incidence of CUP accounts for approximately 1%–2% of all tumors. CUP progresses rapidly and has a short course. The treatment and prognosis of patients with CUP are closely linked to the primary site. In clinical settings, identifying the primary tumor remains challenging. Scholars have focused on improving the detection rate. Novel technologies, such as gene expression profiling, high-throughput sequencing, epigenetics, and liquid biopsy, have been successively applied to identify the primary tumor of CUP accurately, sensitively and specifically. With the guidance of molecular diagnosis, targeted therapy, immunotherapy, and combination therapy will usher in the era of precision treatment for CUP, which may become a typical example for individualized therapy.

Intervention effect of Chuanxiong-Chishao herb pair on circRNA/lncRNA expression profile in a myocardial infarction-atherosclerosis model / 中国中药杂志

This study aimed to explore the intervention effect of Chuanxiong-Chishao herb pair(CX-CS) on a myocardial infarction-atherosclerosis(MI-AS) mouse model and investigate its effect on the expression profile of circular RNAs(circRNAs)/long non-coding RNAs(lncRNAs) in ischemic myocardium and aorta. Sixty male ApoE~(-/-) mice were randomly assigned to a model group, high-, medium-, and low-dose CX-CS groups(7.8, 3.9, and 1.95 g·kg~(-1)), and a positive drug group(metoprolol 26 mg·kg~(-1) and simvastatin 5.2 mg·kg~(-1)), with 12 mice in each group. Male C57BL/6J mice were assigned to the sham group. The mice in the model group and the groups with drug intervention were fed on a high-fat diet for 10 weeks, followed by anterior descending coronary artery ligation. After that, the mice were fed on a high-fat diet for another two weeks to induce the MI-AS model. The mice in the sham group received normal feed, followed by sham surgery without coronary artery ligation. Mice in the groups with drug intervention received CX-CS or positive drug by gavage for four weeks from the 9th week of high-fat feeding, and those in the model group and the sham group received an equal volume of normal saline. Whole transcriptome sequencing was performed on the heart and aorta tissues of the medium-dose CX-CS group, the model group, and the sham group after administration. The results showed that the medium-and high-dose CX-CS groups showed improved cardiac function and reduced myocardial fibrosis area, and the medium-dose CX-CS group showed significantly reduced plaque area. CX-CS treatment could reverse the expression of circRNA＿07227 and circRNA＿11464 in the aorta of AS model and circRNA expression(such as circRNA＿11505) in the heart of the MI model. Differentially expressed circRNAs between the CX-CS-treated mice and the model mice were mainly enriched in lipid synthesis, lipid metabolism, lipid transport, inflammation, and angiogenesis in the aorta, and in angiogenesis, blood pressure regulation, and other processes in the heart. CX-CS treatment could reverse the expression of lncRNAs such as ENSMUST00000162209 in the aorta of the AS model and TCONS＿00002123 in the heart of the MI model. Differentially expressed lncRNAs between the CX-CS-treated mice and model mice were mainly enriched in lipid metabolism, angiogenesis, autophagy, apoptosis, and iron death in the aorta, and in angiogenesis, autophagy, and iron death in the heart. In summary, CX-CS can regulate the expression of a variety of circRNAs and lncRNAs, and its intervention mechanism in coronary heart disease may be related to the regulation of angiogenesis and inflammation in ischemic myocardium, as well as lipid metabolism, lipid transport, inflammation, angiogenesis in AS aorta.

Establishment of a nomogram prediction model for the etiological type of large vessel occlusive stroke based on clinical and imaging parameters / 国际脑血管病杂志

Objective:To develop a nomogram model based on clinical and imaging parameters to predict the etiological type of acute ischemic stroke (AIS).Methods:Patients with AIS received endovascular treatment in Beijing Hospital from March 2016 to December 2021 were retrospectively included. According to the etiological type, they were divided into large artery atherosclerosis (LAA) and cardioembolism (CE). The clinical and imaging parameters mostly relevant to the etiological type were selected by LASSO regression, and a nomogram model for predicting the etiological type of AIS was established by multifactorial logistic regression to investigate the predictive value of relevant clinical imaging parameters. In addition, the diagnostic efficacy of the prediction model was assessed by receiver operator characteristic (ROC) curves, calibration curves, and clinical decision curves. Results:A total of 136 AIS patients with anterior circulation large vessel occlusion received endovascular treatment were included, including 62 patients with CE (45.6%) and 74 with LAA (54.4%). Variables with P<0.10 in the univariate analysis were included in LASSO regression to screen for relevant variables. The gender, baseline National Institute of Health Stroke Scale (NIHSS) score, penumbra to ischemic core ratio, brain natriuretic peptide (BNP), and platelet (PLT) count were included into the multivariate logistic regression model. The results revealed that gender (odds ratio [ OR] 2.632, 95% confidence interval [ CI] 1.048-6.607; P=0.039), baseline NIHSS score ( OR 1.078, 95% CI 1.002-1.160; P=0.043), BNP ( OR 1.004, 95% CI 1.002-1.007. P<0.001), PLT ( OR 0.991, 95% CI 0.982-0.999; P=0.031) as the predictors to distinguish LAA from CE. In addition, the penumbra to infarct core ratio ( OR 0.886, 95% CI 0.785-1.000; P=0.050) also played an important role in predicting the model. The diagnostic efficacy of this predictive model was analyzed by the ROC curves, with an area under the curve of 0.881 (95% CI 0.815-0.930, P<0.001). Bootstrap internal validation showed that the good compliance with a mean absolute error of 0.027 for true versus predicted value compliance. Calibration curves, clinical decision curves, and Hosmer-Lemeshow test ( P=0.562) showed good agreement between the predicted and actual values of the model. Conclusion:Patients with CE are more common in women, have higher NIHSS scores and BNP, and have lower PLT and penumbra to ischemic core ratio. The nomogram model combining the above indicators can better identify LAA and CE, and maybe helpful in clinical decision making.

Calculation method and empirical analysis of the total amount of price adjustment in medical service price reform / 中华医院管理杂志

In order to further promote the reform of medical service price and strengthen the macro management of medical service price, the author constructed a calculation method for price adjustment space of medical service. This study was centered on two parameters of the historical base and the growth coefficient, to calculate the total amountof price adjustment. The historical base used the total revenue of medical services in the region from the previous year, and the growth coefficient was measured by two methods, the comprehensive indicator method and the consumer price index (CPI) reference method.Taking Suzhou, a national pilot city, as an example, the historical base in 2022 was 18 754 million yuan. By using the comprehensive indicator method, the annual growth coefficient was calculated to be 2.38%, and adjustment space of medical service price was 446.35 million yuan; According to the CPI reference method, the growth coefficient of Suzhou was 2.10%, and adjustment space of medical service price was 393.83 million yuan.The two methods for calculating the total amount each have their own advantages and disadvantages, and need to be further optimized and improved by drawing on the practical experience of reform in each pilot city.

Construction of the evaluation index system on the mechanism of medical service price reform / 中华医院管理杂志

Objective:To design a set of evaluation index system for the medical service price reform mechanism, so as to provide reference for the evaluation of deepening the medical service price reform mechanism.Methods:On the basis of searching literature of medical service prices reformfrom August 2021 to March 2023, policy logic analysis and expert consultation were used to construct evaluation indexes for the medical service price reform mechanism, set evaluation index thresholds, and assign scores to index thresholds in different grades.Results:The evaluationindex system of medical service price reform mechanism included 5 level-1 indexes, 12 level-2 indexes and 35 level-3 indexes. After scoring, the scores of 5 level-1 indexes were 12, 24, 35, 21, and 8, respectively.Based on the percentile scoring method, the evaluation criteria were categorized into five grades: premium, excellent, good, average and failure.Conclusions:This study constructed a set of evaluation index system for the mechanism of medical service price reform, which had strong scientific and operability. However, due to the fact that medical service price reform in the new era is still in its initial stage, the index system need to be further optimized drawing on the practical experience of reforms in pilot cities.

Analysis of bacterial spectrum and variability of drug resistance of bile in patients with common bile duct stones and biliary tract infections / 中华消化杂志

Objective:To analyze the distribution of pathogenic bacteria in bile culture in patients with common bile duct stones and biliary tract infections, in order to guide clinical optimization of antibiotics application.Methods:From March 30, 2017 to December 31, 2021, at Affiliated Hospital of Qingdao University, 753 patients with common bile duct stones and biliary tract infections and received endoscopic retrograde cholangiopancreatography were selected. Bile samples were obtained for bacterial culture, strain type identification and drug sensitivity test in order to analyze bile pathogenic bacteria distribution, change trend and drug resistance. Chi-square test was used for statistical analysis.Results:From 2017 to 2021, the total positive rate of bile culture in 753 patients with choledocholithiasis complicated with biliary tract infection was 90.17% (679/753). From 2017 to 2021, the positive rates of bile culture were 82.05% (64/78), 88.81% (119/134), 88.03% (125/142), 93.87% (199/212), and 91.98% (172/187), respectively, and the difference was statistically significant ( χ2=10.78, P=0.029). The positive rate of bile culture in 2017 was lower than those in 2020 and 2021, and the differences were statistically significant ( χ2=9.43 and 5.57, P=0.002 and 0.018). There were no significant differences in the positive rates of bile culture among the other years (all P>0.05). A total of 1 033 pathogenic bacteria were detected in the 679 bile specimens with positive bile culture results. Among which the total proportion of Gram-negative bacilli was 57.02% (589/1 033), and from 2017 to 2021 the proportions were 66.38% (77/116), 66.47% (111/167), 59.43% (104/175), 54.75% (173/316), and 47.88% (124/259), respectively. The total proportion of Gram-positive cocci was 41.05% (424/1 033), and from 2017 to 2021 the proportions were 31.90% (37/116), 31.74% (53/167), 38.86% (68/175), 44.30% (140/316), and 48.65% (126/259), respectively. The total proportion of fungus was 1.94% (20/1 033), and from 2017 to 2021 the proportions were 1.72% (2/116), 1.80% (3/167), 1.71% (3/175), 0.95% (3/316), and 3.47% (9/259), respectively. From 2017 to 2021, the proportion of Gram-negative bacilli gradually decreased, while the proportion of Gram-positive cocci gradually increased, and the differences were statistically significant ( χ2=20.14 and 17.91, P<0.001 and =0.001). From 2017 to 2021, the change in the proportion of fungus was not statistically significant ( P>0.05). The main Gram-negative bacilli in the bile culture were Escherichia coli (31.36%, 324/1 033) and Klebsiella pneumoniae (12.68%, 131/1 033); the main Gram-positive cocci were Enterococcus faecalis (14.04%, 145/1 033) and Streptococcus salivarius (4.36%, 45/1 033). From 2017 to 2021, the proportions of Escherichia coli were 39.66% (46/116), 38.92% (65/167), 33.14% (58/175), 28.48% (90/316), and 25.10% (65/259), respectively, with gradual decrease and the difference was statistically significant ( χ2=14.34, P=0.006). From 2017 to 2021 the detection rates of extended-spectrum β-lactamase (ESBL) in Escherichia coli and Klebsiella pneumoniae were 30.43% (14/46), 26.15% (17/65), 29.31% (17/58), 38.89% (35/90), 40.00% (26/65), and 4/15, 20.00% (5/25), 20% (5/25), 24.32% (9/37), and 31.03% (9/29), and there were no significant differences in the detection rates of ESBL between different years (both P>0.05). Conclusions:From 2017 to 2021, the positive rate of bile culture in patients with choledocholithiasis complicated with biliary tract infection showed an overall increasing trend. Gram-negative bacilli were still dominated in bile pathogenic bacteria, while the proportion of Gram-positive cocci remarkably increased, and the bile bacterial spectrum significantly changed. Clinicians should adjust the antibiotic dosing regimens according to the variation of bacterial spectrum and drug resistance.

Analysis of disease spectrum and drug consumption of field medical team in field training in summer / 中华急诊医学杂志

Objective:To analyze the common disease spectrum and medication of field medical team in our hospital in summer, and to provide medical and medicinal material supply for field medical team.Methods:The data of all cases of field medical team members during the training period were collected. The types and composition ratio of diseases were analyzed, the drug consumption was counted, and the drug use indicators were calculated including daily drug dose (DDDs), daily drug dose cost (DDDC), drug utilization rate (DUR) and drug ranking ratio (R).Results:During the 12 days of the field training in summer, 77 field medical team members had 91 medical visits and 117 cases of diseases, including 44 males and 33 females, with an average age of 39.7 years. There were 52 cases of respiratory diseases, 21 cases of digestive diseases, 18 cases of mosquito bites and skin diseases, 15 cases of trauma and skeletal muscle system diseases, 5 cases of ophthalmic diseases, 2 cases of neurological diseases, 2 cases of gynecological diseases, 1 case of oral diseases and 1 case of heat stroke. The top five drugs of DDDs and DUR were respiratory drugs, sensory organ drugs, dermatological drugs, antibiotic drugs, digestive system drugs and musculoskeletal system drugs.Conclusions:The disease composition and drug demand of field training in summer have certain characteristics. It is of great guiding significance to know the characteristics of disease incidence and drug consumption of field training for the medical support ability and training tasks for field medical teams in field training in summer.

Assessment of the Benefits of Targeted Interventions for Pandemic Control in China Based on Machine Learning Method and Web Service for COVID-19 Policy Simulation / 生物医学与环境科学（英文）

Taking the Chinese city of Xiamen as an example, simulation and quantitative analysis were performed on the transmissions of the Coronavirus Disease 2019 (COVID-19) and the influence of intervention combinations to assist policymakers in the preparation of targeted response measures. A machine learning model was built to estimate the effectiveness of interventions and simulate transmission in different scenarios. The comparison was conducted between simulated and real cases in Xiamen. A web interface with adjustable parameters, including choice of intervention measures, intervention weights, vaccination, and viral variants, was designed for users to run the simulation. The total case number was set as the outcome. The cumulative number was 4,614,641 without restrictions and 78 under the strictest intervention set. Simulation with the parameters closest to the real situation of the Xiamen outbreak was performed to verify the accuracy and reliability of the model. The simulation model generated a duration of 52 days before the daily cases dropped to zero and the final cumulative case number of 200, which were 25 more days and 36 fewer cases than the real situation, respectively. Targeted interventions could benefit the prevention and control of COVID-19 outbreak while safeguarding public health and mitigating impacts on people's livelihood.

Effectiveness evaluation of comprehensive measures reducing mosquitoes in the underground garages at residential areas in Jiaxing， Zhejiang Province， China / 上海预防医学

Objective:To determine the effect of comprehensive measures at reducing mosquito density in residential parking lot， and to provide scientific evidence for exploring a new mosquito density control mode in parking lot. Methods:During April to October in 2018， a package of measures were implemented in the observation group， including designating a full-time staff， combination of property management and mosquito eradication work， continual clean-up of breeding ground， appropriate use of pesticide， education and training of pest control knowledge， and so on. No intervention was conducted in the control group. Then we observed the effect of the above measures in reducing mosquito density. Results:After the implementation of the comprehensive measures， the average adult mosquito density and infant positive rate of ponding mosquitoes in the residential parking lot in the observation group were significantly lower than those in the control group. The mosquito positive rate in rainwater well， sewage well， drainage ditch and intercepting ditch in the observation group was significantly lower than that in the control group. There were no statistically significant difference between the observation group and the control group in the adult mosquito density and the infant positive rate of ponding mosquito in April. Conclusion:Through a package of comprehensive prevention and control measures， mosquito density in the parking lot at residential areas can be effectively reduced. However， there are still some resistances in the implementation process of measures， which need to be constantly optimized to achieve better on-site prevention and control effect.

Beneficial effects of naringenin and morin on interleukin-5 and reactive oxygen species production in BALB/c mice with ovalbumin-induced asthma

We investigated the effects of naringenin and morin on IL-5 and ROS production in PMA+ionomycin-treated EL-4 cells with the corroboration of their antioxidant and anti-inflammatory properties using an asthma-induced mouse model. The EL-4 cell line was used to study the outcomes of naringenin or morin, followed by cell viability studies. Western blot analysis and ELISA test were used to determine Th2 mediated cytokines. In vivo studies were carried out on BALB/c mice to induce allergic asthma using ovalbumin administered intraperitoneally. Intracellular ROS was determined using 2’,7’-dichlorodihydrofluorescein diacetate, followed by serum enzymatic (AST and ALT) estimations and inflammatory cell count in the bronchoalveolar lavage fluid (BALF) and lung tissues. Histopathological studies were conducted to examine lung tissue-stained architecture. Our findings suggested that naringenin and morin significantly suppressed IL-5 and ROS production via various pathways. Interestingly, by reducing NFAT activity, naringenin and morin stimulated HO-1 expression, thereby suppressing IL-5 secretion due to regulating the transcription factor Nrf2 via P13/Akt or ERK/JNK signalling pathways in EL-4 cells, demonstrating the involvement of HO-1 expression in inhibiting asthmatic inflammation. The increased inflammatory cells in the BALF were substantially decreased by both naringenin and morin, followed by inhibition in the elevated Th-2 cytokines levels. The TNF-α protein levels in an allergic asthma mouse model were significantly reduced by suppressing Akt phosphorylation and eosinophil formation. Recent findings confirmed that naringenin and morin possess the potential to control asthma-related immune responses through antioxidant and anti-inflammatory properties, indicating potential therapeutic agents or functional foods.

Efficacy of revascularization in oldest-old patients with acute ischemic stroke / 中华全科医师杂志

Objective:To analyze the efficacy of revascularization in oldest-old patients with acute ischemic stroke (AIS).Methods:The clinical data of AIS patients receiving recanalization therapy in Beijing Hospital from January 2010 to July 2018 were retrospectively reviewed. Among 141 patients, there were 34 cases aged ≥80 years (oldest-old group) and 107 cases aged<80 years (old group).The clinical characteristics and outcomes of two groups were analyzed and compared.Results:The proportions of patients with atrial fibrillation and coronary heart disease in oldest-old group were high than those in the old group [61.8% (21/34) vs. 33.6%(36/107), χ 2=8.47, P<0.01; 58.8% (20/34) vs. 32.7% (35/107), P<0.01, respectively]; while there were no significant differences in other risk factors between two groups ( P>0.05). The National Institute of Health Stroke Scale Score (NIHSS) was higher in the oldest-old group than that in old group [16 (13,21) vs. 11 (6,16), Z=3.74, P<0.01]. In the etiological classification, cardiogenic embolism was the main cause in the oldest-old group (58.8%, 20/34), while large artery atherosclerosis was the main cause in the old group (46.7%, 50/107, χ 2=12.11, P<0.01). There were no significant differences between the two groups in the methods of recanalization [intravenous thrombolysis were 35.3% (12/34) and 48.6% (52/107); endovascular therapy were 52.9% (18/34) and 36.4% (39/107), bridging therapy were 11.8% (4/34) and 15.0% (16/107), respectively; χ 2=2.93, P=0.23] and the time from onset to treatment [195(154, 269) min vs. 215 (153,280)min, Z=1.03, P>0.05]. The 3-month independent (modified Rankin score ≤2) rate was lower in the oldest-old group than that in the old group [35.3% (12/34) vs. 56.1%(60/107), χ 2=4.46, P<0.05). The 3-month mortality was higher in the oldest-old group than that in the old group [29.4% (10/34) vs. 8.4%(9/107), χ 2=9.76, P<0.01]. There was a tendency of increased incidence of symptomatic intracranial hemorrhage (SICH) in the oldest-old patients compared to the old patients [11.8% (4/34) vs. 7.5% (8/107), P>0.05]. Conclusion:The conditions of AIS patients aged ≥80 years are more serious than those of patients aged<80 years, with higher mortality and lower functional improvement rate after recanalization treatment.

Efficacy of revascularization in oldest-old patients with acute ischemic stroke / 中华全科医师杂志

Objective@#To analyze the efficacy of revascularization in oldest-old patients with acute ischemic stroke (AIS).@*Methods@#The clinical data of AIS patients receiving recanalization therapy in Beijing Hospital from January 2010 to July 2018 were retrospectively reviewed. Among 141 patients, there were 34 cases aged ≥80 years (oldest-old group) and 107 cases aged<80 years (old group).The clinical characteristics and outcomes of two groups were analyzed and compared.@*Results@#The proportions of patients with atrial fibrillation and coronary heart disease in oldest-old group were high than those in the old group [61.8% (21/34) vs. 33.6%(36/107), χ2=8.47, P<0.01; 58.8% (20/34) vs. 32.7% (35/107), P<0.01, respectively]; while there were no significant differences in other risk factors between two groups (P>0.05). The National Institute of Health Stroke Scale Score (NIHSS) was higher in the oldest-old group than that in old group [16 (13,21) vs. 11 (6,16), Z=3.74, P<0.01]. In the etiological classification, cardiogenic embolism was the main cause in the oldest-old group (58.8%, 20/34), while large artery atherosclerosis was the main cause in the old group (46.7%, 50/107, χ2=12.11, P<0.01). There were no significant differences between the two groups in the methods of recanalization [intravenous thrombolysis were 35.3% (12/34) and 48.6% (52/107); endovascular therapy were 52.9% (18/34) and 36.4% (39/107), bridging therapy were 11.8% (4/34) and 15.0% (16/107), respectively; χ2=2.93,P=0.23] and the time from onset to treatment [195(154, 269) min vs. 215 (153,280)min, Z=1.03, P>0.05]. The 3-month independent (modified Rankin score ≤2) rate was lower in the oldest-old group than that in the old group [35.3% (12/34) vs. 56.1%(60/107), χ2=4.46, P<0.05). The 3-month mortality was higher in the oldest-old group than that in the old group [29.4% (10/34) vs. 8.4%(9/107), χ2=9.76, P<0.01]. There was a tendency of increased incidence of symptomatic intracranial hemorrhage (SICH) in the oldest-old patients compared to the old patients [11.8% (4/34) vs. 7.5% (8/107), P>0.05].@*Conclusion@#The conditions of AIS patients aged ≥80 years are more serious than those of patients aged<80 years, with higher mortality and lower functional improvement rate after recanalization treatment.

Carotid artery stenting in octogenarians : Clinical observation and follow-up / 中华老年医学杂志

Objective To observe the safety and long-term efficacy of carotid artery stenting (CAS)in octogenarians with carotid stenosis.Methods Clinical data of patients aged 80 years or older undergoing CAS for carotid stenosis in our hospital between July 2008 and October 2017 were retrospectively analyzed.The perioperative treatment outcomes and mid-and long-term follow-up results were analyzed.Results A consecutive series of 61 patients (a median age of 81 years,54 males) were enrolled.Of 61 patients,23 (37.7％)patients had symptomatic carotid artery stenosis.Sixty patients underwent unilateral CAS,one patient underwent bilateral CAS,and 26 (42.6 ％)underwent other cerebrovascular interventional therapy during the same period.The technical success rate was 100.0％.During the perioperative period,the incidence of stroke was 6.6％ (4/61),and no patient died.Eight (13.1％) patients had contrast-induced nephropathy,4 (6.6％) patients suffered from cardiac dysfunction,and 30 (49.2％)patients had hypotension requiring vasopressor support postoperatively,and all of them recovered well when discharged from hospital.All patients were followed up for a median of 42 months(range 2-108 months,with an interquartile interval of 44 months).The incidence of stroke and death was 8.2％ (5/61)within 30 days to 1 year after surgery.The median stroke-free survival was 72 months in patients with symptomatic carotid stenosis,and was 93 months in asymptomatic patients,with the statistically significant difference between the two groups(x2 =4.258,P=0.039).Conclusions Carotid artery stent implantation in octogenarians with carotid stenosis has a favorable safety and feasibility when performed in experienced centers,and the outcome of a mid-and long-term follow-up is good.

Carotid artery stenting in octogenarians: Clinical observation and follow-up / 中华老年医学杂志

Objective@#To observe the safety and long-term efficacy of carotid artery stenting(CAS)in octogenarians with carotid stenosis.@*Methods@#Clinical data of patients aged 80 years or older undergoing CAS for carotid stenosis in our hospital between July 2008 and October 2017 were retrospectively analyzed.The perioperative treatment outcomes and mid- and long-term follow-up results were analyzed.@*Results@#A consecutive series of 61 patients(a median age of 81 years, 54 males)were enrolled.Of 61 patients, 23(37.7%)patients had symptomatic carotid artery stenosis.Sixty patients underwent unilateral CAS, one patient underwent bilateral CAS, and 26(42.6%)underwent other cerebrovascular interventional therapy during the same period.The technical success rate was 100.0%.During the perioperative period, the incidence of stroke was 6.6%(4/61), and no patient died.Eight(13.1%)patients had contrast-induced nephropathy, 4(6.6%)patients suffered from cardiac dysfunction, and 30(49.2%)patients had hypotension requiring vasopressor support postoperatively, and all of them recovered well when discharged from hospital.All patients were followed up for a median of 42 months(range 2-108 months, with an interquartile interval of 44 months). The incidence of stroke and death was 8.2%(5/61)within 30 days to 1 year after surgery.The median stroke-free survival was 72 months in patients with symptomatic carotid stenosis, and was 93 months in asymptomatic patients, with the statistically significant difference between the two groups(χ2=4.258, P=0.039).@*Conclusions@#Carotid artery stent implantation in octogenarians with carotid stenosis has a favorable safety and feasibility when performed in experienced centers, and the outcome of a mid- and long-term follow-up is good.

A root-cause analysis of poor prognosis in patients aged 80 years and over with acute ischemic stroke after mechanical thrombectomy / 中华老年医学杂志

Objective To explore the safety and effectiveness of mechanical thrombectomy in patients ≥80 years old,and to analyze the causes of poor prognosis.Methods The data of twenty consecutive patients ≥ 80 years old with acute ischemic stroke who underwent mechanical thrombectomy in our hospital from January 2017 to June 2018 were retrospectively reviewed.Baseline information,imaging data,thrombectomy procedures,complications,and clinical prognosis were collected.The causes of poor prognosis were analyzed.Results A total of 20 advanced age patients were included,with an average age of (83.3±4.1)years(range 80 to 96 years).All patients underwent mechanical thrombectomy,and the successful recanalization rate(mTICI 2b-3)was 70 ％.The incidence of technical complications was 15％,of which the rate of symptomatic intracranial hemorrhage was 5％.Among the 11 patients with poor prognosis,the causes included the severe diseases and later revascularization in 2 patients,unsuccessful recanalization or complications in 3 cases,and advanced age-related factors in 6 cases,among which there were accompanied multiple severe stenoses,poor collaterals and the rapid progress of stroke in 3 cases and the aggravation of previous comorbidities in 3 cases.Conclusions The advanced age patients ≥80 years old often have more comorbidities,higher prevalence rates of multiple severe vascular stenosis except the occluded vessels,poor collateral compensation and the aggravation of original comorbidities.And all of them may be important factors for the poor prognosis after mechanical thrombectomy.

Efficacy of different vascular recanalization methods for acute ischemic stroke / 中华全科医师杂志

Objective To assess the efficacy of different vascular recanalization methods for acute ischemic stroke (AIS). Methods The clinical data of AIS patients receiving vascular recanalization therapy in Beijing Hospital from January 2010 to July 2018 were retrospectively analyzed. Among 141 AIS patients, 64 received intravenous thrombolysis (IVT group), 57 received endovascular treatment (EVT group) and 20 received intravenous thrombolysis and endovascular treatment (IVT+EVT group). The efficacy and safety of therapy were compared among three groups. Results There were no significant differences in the risk factors of cerebrovascular diseases among 3 groups (P>0.05). The National Institute of Health Stroke Scale(NIHSS) scores [M(Q1,Q3)] of patients in the IVT group, EVT group and IVT+EVT group were 9.5 (6.0, 15.0), 15.0 (9.0,19.0) and 14.0(8.3,17.0), respectively (Z=7.19, P<0.05). The time from onset to treatment in the three groups was 205.0 (156.3, 254.3) min, 260.0 (170.0, 401.5) min, and 137.5 (90.3, 137.5) min, respectively (Z=22.83, P<0.01). The proportion of large arteries occlusion was lower in IVT group (32.8％, 21/64), compared with EVT group (86.0％, 49/57) and IVT+EVT group (95.0％, 19/20) (χ2=46.77, P<0.01). The proportion of symptomatic intracranial hemorrhage in IVT group was lower than EVT and IVT+EVT group [1.6％ (1/64) vs. 15.8％ (9/57) and 10.0％ (2/20), χ2=8.36, P<0.05]. The favorable outcome rates in IVT, EVT and IVT+EVT groups at the 90 d (mRS score≤2) were 57.8％ (37/64), 45.6％ (26/57) and 40.0％(8/20), respectively (χ2=2.79, P=0.24). The fatality rates in three groups were 10.9％ (7/64), 19.3％ (11/57) and 5.0％ (1/20), respectively (χ2=2.84, P=0.21). Conclusions Intravenous thrombolysis, endovascular therapy and bridging therapy have similar effects on the prognosis of AIS. Mild severity of AIS patients are more likely to benefit from intravenous thrombolysis. AIS patients with severe disease are usually combined with large artery occlusion, and more suitable for endovascular treatment and bridging treatment.

Investigation of zero echo time arterial spin labeling MR angiography in the follow-up of endovascular treatment of intracranial aneurysm / 中华放射学杂志

Objective@#To investigate the value of zTE ASL MRA in the follow-up of interventional treatment of intracranial aneurysm at 1.5 T, using DSA as gold standard.@*Methods@#Patients with intracranial aneurysms who underwent coil embolization with or without stent were enrolled in this study. Both TOF MRA and zTE ASL MRA were performed on a 1.5T whole body scanner (MR360, GE, USA) equipped with an 8 channel head coil, and DSA was performed within one week of the MR examinations. Aneurysmal remnant and intra-stent opacity were analyzed. SE, PE, PPV, NPV of two MRA modalities in aneurysm recanalization detection were calculated. Kappa coefficient was used to determine the inter-reader and intra-reader reproducibility. Paired t test was used to test the visibility of in-stent lumen on two kinds of MRA.@*Results@#A total of 24 patients (27 aneurysms) were included in this study, 23 aneurysms were treated with stent assisted embolization, four coil embolization. Thirteen cases of aneurysm remnant were detected by DSA, 15 by zTE ASL and 11 by TOF MRA. zTE ASL MRA had a relatively higher SE (100%) and NPV(100%) as compared with TOF MRA. The Kappa value in identification of aneurysm remnant was 0.85 between zTE MRA and DSA and 0.70 between TOF MRA and DSA, respectively. The inter-reader reproducibility was good (Kappa 0.70), while the intra-reader reproducibility was excellent(Kappa 0.85). There was statistical significance in the scoring results of the in-stent lumen visibility.@*Conclusion@#zTE ASL MRA proved to be a better imaging modality as compared to TOF MRA to evaluate the endovascular treatment effectiveness of intracranial aneurysms, especially for assessing the aneurysmal recurrence and in-stent lumen visibility.