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Objective:To compare the safety and efficacy of ticagrelor and clopidogrel in dual antiplatelet therapy for stent-assisted embolization of unruptured intracranial aneurysms.Methods:Patients with unruptured intracranial aneurysms received stent-assisted embolization in the Department of Neurosurgery, Linyi People's Hospital from January 2021 to June 2022 were retrospectively included. According to the preprocedural dual antiplatelet therapy scheme, they were divided into aspirin+clopidogrel group (clopidogrel group) and aspirin+ticagrelor group (ticagrelor group). The incidence of ischemic and bleeding events was compared between the clopidogrel group and the ticagrelor group at 3 months after procedure. Multivariate logistic regression model was used to analyze independent risk factors for postprocedural ischemic and bleeding events. Results:A total of 195 patients were included. Their age was 58.15±10.11 years and 75 were males (38.5%). There was no statistically significant difference in the incidence of bleeding events (12.8% vs. 5.9%) and ischemic events (14.9% vs. 18.8%) at 3 months after procedure between the ticagrelor group ( n=94) and the clopidogrel group ( n=101). Multivariate logistic regression analysis showed that smoking (odds ratio [ OR] 6.085; 95% confidence interval [ CI] 1.589-13.012; P=0.019], hypertension ( OR 4.547, 95% CI 1.589-13.012; P=0.005), aneurysm at the branch vessel ( OR 3.089, 95% CI 1.122-8.504; P=0.029), and the use of flow diverter ( OR 3.111, 95% CI 1.062-9.110; P=0.038) were the independent risk factors for postprocedural ischemic events. Triglycerides might be an independent risk factor for postprocedural bleeding events ( OR 1.435, 95% CI 0.989-2.082; P=0.057), but did not reach statistical significance. Conclusions:In dual antiplatelet therapy for stent-assisted embolization of unruptured intracranial aneurysms, ticagrelor and clopidogrel have the same safety and efficacy.
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Objective:To design a modified S1PR3 specific agonist, GPS-725.017, and investigate its protective effect on acute lung injury by promoting macrophage clearance of bacteria.Methods:A short peptide derived from the intracellular region of S1PR3 receptor was named GPS725.017, which was modified with norleucine (Nle) and myristicacid (myr) at its N terminus. Mice were divided into the sham operation group, solvent group and GPS-725.017 treatment group. The acute lung injury model was induced by endotracheal injection of E. coli (5×10 6 CFU), and the experimental group was treated with GPS-725.017 (10 mg/kg). The 48-h survival rate of mice was recorded. After 5 h of modeling, the bacterial load and inflammatory cytokines in peripheral blood and lung were detected, and Vps34 protein content in alveolar macrophages was determined by Western blot. After 12-h of modeling, lung tissues were collected for H&E staining and pathological scores. Results:Compared with the solvent group, the survival rate of mice in the GPS-725.017 treatment group was significantly improved ( P<0.01), the bacterial CFU in blood and alveolar lavage fluid was significantly lower than that in the solvent group ( P<0.001), and the levels of TNF-α and IL-1β in blood and alveolar lavage fluid were significantly lower than those in the solvent group ( P<0.001). Western blot showed that the expression level of Vps34 protein in alveolar macrophages was significantly higher than that in the solvent group ( P<0.01). Histopathology result showed that the pathological damage of lung in the treatment group was significantly less than that in the solvent group ( P<0.001). Conclusions:The modified synthetic S1PR3 specific agonist GPS-725.017 could specifically activate the S1PR3 receptor on the membrane of alveolar macrophages and up-regulate the expression level of intracellular Vps34 protein, which can promote the removal of bacteria in alveolar macrophages, significantly reduce the degree of lung injury and improve the survival rate in ALI mice.
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Objective To analyze the risk factors for cerebral apoplexy in the recipients after renal transplantation. Methods Clinical data of 376 renal transplant recipients who were followed up regularly were retrospectively analyzed. The recipients were divided into cerebral apoplexy group (39 cases) and non-cerebral apoplexy group (337 cases) according to the occurrence of cerebral apoplexy. The risk factors of cerebral apoplexy were analyzed using single factor analysis and COX proportional hazards regression model. Results The 376 recipients were followed up for a median duration of 55 months, among whom 39 recipients suffered from cerebral apoplexy, with a cumulative incidence of 10.4%. Single factor analysis indicated that there were significant differences in age ≥40 years old at transplantation, duration of dialysis ≥12 months before transplantation, estimated glomerular filtration rate (eGFR) <30 mL/(min·1.73m2), incidence of hypertension, diabetes and dyslipidemia between cerebral apoplexy group and non-cerebral apoplexy group (all P<0.05).Multivariate analysis indicated that the independent risk factors for cerebral apoplexy occurred in the recipients after renal transplantation were age ≥40 years old [hazard ratio (HR) =1.110, 95% confidence interval (CI)=1.067-1.154,P=0.000],duration of dialysis≥12 months before transplantation(HR=1.044,95%CI=1.021-1.067,P=0.000)and eGFR<30 mL/(min·1.73m2)(HR=2.448,95%CI=1.197-5.005,P=0.014).Conclusions The independent risk factors for cerebral apoplexy in the recipients after renal transplantation include age≥40 years old, long duration of dialysis before transplantation and renal insufficiency.
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Objective To investigate the occurring time,pathogen distribution and drug resistance in kidney transplant pa-tients with lung infection and to provide basis for clinical treatment.Methods From January 2012 to December 2015,73 kid-ney transplant patients with lung infection were collected in this study.The timing of infection occurrence,the main source of specimen,the pathogenic bacteria and drug resistance of each case were analyzed retrospectively.The drug sensitivity was analyzed by WHONET 5.4 software.Results 83.56% (61/73)cases of lung infection occurred within 1 year in kidney transplant patients,among them,53.42% (39/73)cases occurred within 6 month after kidney transplantation,and 30.14%(22/73)cases occurred within 6~12 months after surgery.The 84.93% (62/73)source of specimen were sputum and blood,and the others were alveolar lavage fluid,pleural fluid and throat swab.Totally 7 9 strains of pathogenic bacteria were isolated,including gram negative bacilli (49.37%),gram positive bacteria (39.24%)and fungi (11.39%).The most com-mon strains were Pseudomonas aeruginosa 12 strains (15.19%),Staphylococcus aureus 11 strains (13.92%),Klebsiella pneumoniae 10 strains (12.66%),Staphylococcusaureus 9 strains (11.39%),BaumanAcinetobacter 8 strains (10.13%), and Escherichia coli 6 strains (7.5 9%).The detection rate of strains which producing broad-spectrumβ-lactamases were 30.0% in Escherichiacolil and 20.0% in Klebsiellapneumonia,respectively.Furthermore,the detection rate of methicillin-resistant Staphylococcus were 45.45% in Staphylococcusepidermidisl and 22.22% in Staphylococcusaureus,respectively. The drug sensitivity results showed that the Gram-negative bacilli were sensitive to Vancomycin,teicoplanin and rifampicin. The Gram-positive cocci were sensitive to Cefepime,meropenem and imipenem.Conclusion 83.56% (61/73)cases of lung infection occurred within 1 year in kidney transplant patients;Gram-negative bacteria were the main pathogenic bacteria in lung infection in kidney transplant patients;Gram-negative bacteria and Gram-positive bacteria were multi drug resistant and should be treated as early as possible.
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Objective To investigate diagnostic value of the serum creatinine (Scr),Cystatin C (Cys C),MDRD and Le Bricon formula in the renal function after renal transplantation.Methods The total renal glomerular filtration rate (GFR)of 5 7 ca-ses of renal transplantation patients and 48 healthy control group were determined using 99mTc-DTPA from 2012 September to 2014 June.Scr,Cys C and calculate the estimated glomerular filtration rate of MDRD and Le Bricon,correlation analysis by Spearman,and use receiver operating characteristic curve (ROC)to evaluate the diagnosis value.Results DTPA,Scr, Cys C,MDRD and Le Bricon intransplantation group was 60.69±13.52 ml/min/1.73m2,1.34±0.28 mg/dl,1.42±0.15 mg/dl,66.97±15.85 ml/min/1.73m2 and 59.93±10.23 ml/min/1.73 m2 ,respectively.Control group were 90.12±12.61 ml/min/1.73m2 ,0.97±0.09 mg/dl,0.86±0.2 mg/dl,87.13±18.29 ml/min/1.73m2 and 94.80±18.73 ml/min/1.73m2 , respectively.There were statistically significant (t=0.237~1.35,P< 0.01)among groups.Scr,Cys C,MDRD and Le Bri-con between DTPA were different correlation (r=-0.76~0.82,P<0.01).The area under ROC curve were 0.856,0.973, 0.814 and 0.971,respectively.Conclusion Scr,Cys C,MDRD,Le Bricon have some predictive value to chronic kidney dis-ease in all patients after renal transplant recipients,but Cys C and Le Bricon were superior to the Scr and MDRD equation.
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Objective To explore the application of high frequency ultrasonography in the rapid diagnosis of irreducible radial head subluxation in children.Methods Twenty-three patients aged 1 to 5 with unilateral radial head subluxation in children were observed by high-frequency ultrasonography and radiography,and then compared the symptomatic to the contralateral side.Results No case of radial head subluxation was found by radiography.23 cases of radial head subluxation were found by high frequency ultrasonography,10 cases with articular cavity effusion.On the diagnosis of radial head subluxation in children,the sensitivity of high frequency ultrasonography was obviously higher than that of radiography.Conclusions The sensitivity of high frequency ultrasonography in the rapid diagnosis of the radial head subluxation in children is obviously higher than that of X ray film.High frequency ultrasonography through continuous scan can determine the continuity of anatomical structure and the relationship between some views to show the location of the specific structure relations.Specifically,it can be quickly and clearly diagnosed on anterior long-axis view and the lateral coronal view of radiohumeral joint.