Safety and efficacy of intra-arterial tirofiban infusion in patients with acute cardiogenic cerebral embolism undergoing endovascular reperfusion therapy / 中华内科杂志

Objective:To evaluate the safety and efficacy of intra-arterial tirofiban infusion during endovascular reperfusion therapy in patients with acute cardiogenic cerebral embolism.Methods:Clinical data of 72 patients with acute cardiogenic cerebral embolism caused by large artery occlusion were retrospectively analyzed in Department of Neurology, Strategic Support Force Medical Center from August 2015 to August 2020.Among those, 52 patients were treated with intra-arterial tirofiban, the other 20 patients were treated with control medication. The baseline characteristics, modified thrombolysis in cerebral infarction (mTICI) score of responsible vessels, modified Rankin scale (mRS) score 90 days after operation, incidence of symptomatic intracranial hemorrhage and mortality were evaluated and compared in two groups.Results:The proportion of effective recanalization of the offending vessels (mTICI≥2b) in tirofiban group was higher than that in control group (92.3% vs. 75.0%), but the difference was not statistically significant ( P=0.104). At 90 days after operation, the rate of patients with good prognosis (mRS≤2) in tirofiban group (61.5%) was significantly higher than that in control group (35.0%) ( P<0.05). The incidence of symptomatic intracranial hemorrhage and mortality were comparable between the two groups ( P>0.05). Conclusion:Intra-arterial tirofiban infusion in patients with acute cardiogenic cerebral embolism is effective and feasible, which improves the prognosis without increasing the risk of intracranial bleeding complications.

Study on Chemical Constituents of Ethanol Extract from Euonymus amygdalifolius / 中国药房

OBJECTIVE:To study the chemical constituents of Euonymus amygdalifolius.METHODS:Silica gel column chromatogram,gel column chromatogram,TLC and semi-preparative HPLC were adopted to isolate and purify ethanol extract from E.amygdalifolius.The structure of compounds was analyzed and identified according to physical and chemical properties,spectral data (mass spectrurn,hydrogen spectrum and carbon spectrum).RESULTS:Ten compounds were isolated from ethanol extract of aerial part of E.amygdalifolius,i.e.taraxerol (1),sophoradiol (2),taraxerone (3),sorghumol (4),heptaecanoic acid (5),octadecenoic acid (6),β-Sitosterol (7),daucosterol (8),epifriedelinol (9) and friedelin (10).CONCLUSIONS:Above compounds are all isolated from E.amygdalifolius for the first time;compounds 1,2,4,5,6 are isolated and obtained from Euonymus A.for the first time.The study lay a foundation for quality evaluation of E.amygdalifolius.

Prognostic analysis of arterial embolectomy of acute cardiogenic cerebral embolism caused by atrial fibrillation / 中国脑血管病杂志

Objective To investigate the related factors of the prognosis of arterial embolectomy of acute cardiogenic cerebral embolism caused by atrial fibrillation.Methods The clinical data of using vein thrombolysis bridging artery embolectomy or arterial embolectomy alone for the treatment of patients with acute cardiogenic cerebral embolism of cerebral large artery occlusion due to atrial fibrillation were analyzed retrospectively.From January 2015 to December 2016,22 consecutive inpatients with cardioembolic cerebral embolism caused by paroxysmal or persistent atrial fibrillation were enrolled,including 10 patients with the 90-day modified Rankin Scale (mRS) score 0-2 (good recovery group) and 12 patients with mRS scores 3-6 (poor recovery group).The clinical features,imaging data,and treatment of the patients in both groups were compared.The factors such as age,gender,preoperative international standardization ratio (INR),embolism position,whether bridging vein thrombolysis before thrombectomy,National Institutes of Health Stroke Scale (NIHSS) score at the onset,time of onset to reperfusion (TOR),whether using tirofiban,times of thrombectomy,modified Thrombolysis In Cerebral Infarction (mTICI) blood flow grade,and postoperative intracranial symptomatic intracerebral hemorrhage were analyzed.Results There were no significant differences in age,gender,preoperative INR,embolism position,the number of intravenous thrombolysis before thrombectomy,the number of using tirofiban in surgery,the proportion of the above mTICI 2b grade,and the proportion of symptomatic cerebral hemorrhage after surgery of the patients between the two groups (P>0.05).The NIHSS score 15.2±2.0 at the onset in the good recovery group was lower than 22.9±8.4 in the poor recovery group.There was significant difference between the two groups (P<0.05).The TOR time (307±86 min) in the good recovery group was less than that of the poor recovery group (426±145 min).There was significant difference between the two groups (P<0.05).Embolectomy was performed 1.5 (0.5,3.0) times in the good recovery group,which was less than the poor recovery group (4.0 [2.0,7.0] times).There was significant difference between the two groups (P<0.05).Conclusions Shortening the time of reperfusion and reducing the number of embolectomy during operation are the important factors for improving the prognosis of patients when atrial fibrillation causes arterial embolectomy in patients with acute cerebral embolism.However,a study of larger sample is needed for further exploration.

Application of hemostatic silk shielding on ulcers induced by endoscopic submucosal dissection / 中国内镜杂志

Objective To investigate the clinical value of hemostatic silk in prevention of wound bleeding and wound healing after endoscopic submucosal dissection (ESD). Methods Experiment group: animal model was made by rabbit underwent ESD simulation in its' stomach and laying hemostatic silk on its' wound;control group: animal model was made by pig underwent ESD simulation in its' colon without any healing management. All the ulcers sites were endoscopically and pathologically examined to evaluate the hemorrhage and healing of the wound on 3 days, 1 week, 2 weeks and 4 weeks after the procedure. Results The blood loss in experiment group was significantly lower than that in control group. The wounds of all the experimental pigs underwent colon ESD successfully covered with hemostatic silk postoperatively. Endoscopic pathological examination shown better healing procedure in experiment group. No procedure-related adverse event occurred in both groups. Conclusions Hemostatic silk has potential application value in healing the wound after ESD demonstrated by animal experiment.

Clinical analysis of difficult intraarterial mechanical thrombectomy in patients with acute ischemic stroke / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the causes and strategy of difficult intraarterial mechanical thrombectomy (≥3 times) in patients with acute ischemic stroke (AIS).</p><p><b>METHODS</b>The clinical data of 8 cases of AIS with thrombectomy ≥3 times admitted in Department of Neurology, the 306(th) Hospital of People's Liberation Army from June to October in 2015 was analyzed retrospectively. There were 7 male and 1 female patients, aged from 38 to 86 years with an average age of (70±15) years, in which 5 cases were cardiogenic cerebral embolism and 3 cases were large artery atherosclerotic infarction. The National Institute of Health stroke scale (NIHSS) score (M (QR)) was 16 (12) before procedure and modified thrombolysis in cerebral infarction (mTICI)score were 0 in all the patients. Solitaire AB was used in thrombectomy in the occlusion of the arteries.</p><p><b>RESULTS</b>The causes of difficult intraarterial thrombectomy included multiple thrombus, tortuosity in vascular paths, guiding catheter being placed below the internal carotid artery siphon leading to weak strength of suction and support of stent, embolus dropping in the thrombectomy and inadequate anesthesia. After successful thrombectomy 3 cases had mTICI score of 2a, 4 cases of 2b, 1 case of 3. The NIHSS score was 5 (24) at 7(th) day after treatment. At the 90-day follow-up 5 patients had good prognosis (modified Rankin score 0 to 2) and 3 had disability (modified Rankin score 3 to 4).</p><p><b>CONCLUSION</b>Cases of AIS with difficult intraarterial thrombectomy can be treated by improving thrombectomy materials and technique, reasonable anesthesia and perioperative medication in decision-making strategy.</p>

Application of covered esophageal stent applied in esophageal perforation (40 cases) / 中国内镜杂志

Objective To investigate the efficacy and safety of covered stent in treatment of esophageal perforation. Methods Observe and analyzed the effect and complications of covered metallic stent in esophageal perforation. In all of 40 cases, the most common causes were iatrogenic, esophageal cancer, and foreign body. Results All patients with esophageal perforation got successful esophageal stent placement. All of them recovered smoothly in eating. The stents were removed 4 days to 1 month later. Gastroscopy and angiography confirmed esophageal perforation has healed. 3 cases of esophageal cancer patients with dysphagia obviously relieved after stent placement. The main complications in stent and stent migration for chest pain after operation. 6 cases (15 %) of patients with stent displacement, while 2 cases (5 %) of esophageal cancer patients with food obstruction and stent displacement. Conclusion Treatment of esophageal perforation with covered metal stents endoscopically is effective and safe.

Advances in Study on Endoscopic Management of Iatrogenic Gastrointestinal Perforation / 胃肠病学

Iatrogenic gastrointestinal perforation is one of the severe adverse events of endoscopic therapeutic procedure. For acute iatrogenic perforation,management by endoscopic techniques is a simple and rapid modality to close the perforation with minimal invasiveness and avoiding the traditional surgical trauma. Endoclips,suture with special instruments,covered stents,degradable sheets combined with tissue adhesive,and combined endoscopic techniques such as snares combined with endoclips,are the major endoscopic therapeutic modalities for closure of iatrogenic gastrointestinal perforation. In this article,the current status and progress of endoscopic management for acute iatrogenic gastrointestinal perforation were reviewed.

Comparative study between stenting and medication for vertebral artery origin stenosis / 中国脑血管病杂志

Objective Tocomparetheefficacybetweenstentingandmedicationinpatientswith vertebralarteryoriginstenosis.Methods Theclinicaldataof82patientswithmoderatetoseverevertebral artery origin stenosis (stenosis rate >50%)from January 2011 to January 2013 were analyzed retrospectively. They were divided into either a stent+medication group (n=40)or a medication group (n=42)according to the different treatment methods. The degree of vascular stenosis,restenosis rate,incidence of cerebral ischemic events,and National Institutes of Health Stroke Scale (NIHSS)of the patients for DSA reexamination at one year were documented,and comprehensive analysis were conducted. Results (1 )44 stents were implanted in 40 patients,1 of the patients still had residual stenosis of 60% because of the stenosis plaque was harder despite twice balloon dilations. No serious perioperative complications occurred. The success rate of the operation was 97. 5%. The vascular stenosis rate of vertebral artery origins in patients of the stent+medication group was improved significantly,and decreased from 73 ± 13% to median 11%(8%,50%)at one year after stenting. (2)After 1 year,11 patients (27. 5%)had in-stent restenosis in the stent +medication group,including 2 patients (5%)had stent fracture at the same time. Four patients (9. 5%)in the medication group had complete occlusion of vertebral artery,but only 2 had corresponding clinical symptoms. (3)There was no significant difference in the NIHSS scores after the treatment between the stent+medication group and the medication group (Z=1. 678,P=0. 093). The total ischemic events in patients of the stent+medication group was 7 (17. 5%),compared with the incidence of ischemic events in 16 patients (38. 1%)in the medication group,there was significant difference (χ2 =4. 306, P=0.038).Conclusion Stentingissafeandeffectiveforpatientswithvertebralarteryoriginstenosis.It may significantly improve vertebral stenosis,and it is better than medication alone for preventing the occurrence alone of the posterior circulation ischemic events,however,the high in-stent restenosis rate for vertebral artery origin stenosis is still an important problem to be solved.

Investigation and analysis of clinical obstetrics and gynecology clinicians' mastery of basic skills and its influencing factors / 中华医学教育探索杂志

Objective To investigate and analyze clinical obstetrics and gynecology clinicians' mastery of basic skills, and then find the way to help clinicians master basic clinical skills. Methods A self-designed questionnaire survey was conducted among 310 clinicians working in 1-3 grade hospital from Chongqing, Sichuan, Guizhou, Yunnan provinces anonymously by spot field investigation and letter-investigations from February 1, 2015 and to March 31, 2015. The data were analyzed by descriptive analysis, using SPSS 19.0 software package for rank sum test analysis. Result Among 310 valid questionnaires, 31.6% (98) clinicians considered having inadequate clinical skills, 26% (81) average and 42.3%(131) expert. All the basic skills obtained had a relationship with the number of operations, working years and professional title. Most of the basic clinical skills were from working in hospitals 85% (270), journal 82% (254), academic conference 58% (174); 94.2% (293) willing to participate in training classes like clinical teaching and training in moulds. Conclusion The gynecology and obstet-rics basic clinical skills have a great relationship with basic skills training. Providing opportunities for the basic clinical skill trainings, academic conferences, in-service education and establishing regional medical source sharing platform can enhance their clinical skills.

Clinical characteristics of cognitive impairment in the patients with asymptomatic severe internal carotid stenosis / 中国脑血管病杂志

Objective To investigate the clinical characteristics of cognitive impairment in the patients with asymptomatic unilateral severe internal carotid artery stenosis (ICAS). Methods A total of 80 patients with unilateral severe carotid stenosis (stenosis rate ≥70%)and 40 patients without carotid stenosis (control group)diagnosed by digital substract angiography (DSA)were analyzed retrospectively. According to the stenotic sides,the patients with severe ICAS were divided into a left stenosis group and a right stenosis group (n = 40 in each group). The North American Symptomatic Carotid Endarterectomy Trial (NASCET)criteria were used to grade the degree of stenosis. Montreal cognitive assessment (MoCA)was used to evaluate the cognitive function of the patients,and then the cognitive function of the patients in 3 groups was assessed. Results The MoCA total scores,visuospatial and executive functions,and language ability,and delayed memory scores of the patients in both left and right groups were lower than those of the control group. There were significant differences (21. 8 ± 3. 1,3. 4 ± 1. 3,1. 8 ± 0. 6,and 1. 6 ± 1. 3,respec-tively in the left stenosis group;22. 6 ± 2. 5,3. 5 ± 1. 1,1. 9 ± 0. 6,and 1. 7 ± 1. 4,respectively in the right stenosis group;and 26. 4 ± 1. 8,4. 2 ± 0. 9,2. 7 ± 0. 6,and 3. 8 ± 1. 0,respectively in the control group;all P 0. 05). There were no significant differences in the MoCA total scores and each single test score of the patients between the left stenosis and the right stenosis groups (P > 0. 05). Conclusion The patients with asymptomatic unilateral severe ICAS have cognitive impairment generally;it is characterized by delay memory,visuospatial and executive functions,and language dysfunction.

Effectiveness of problem-based learning in naval hygiene teaching / 中华医学教育探索杂志

Objective This paper was performed to investigate the effectiveness of problem-based learning in naval hygiene teaching. Methods Totally 257 clinical medicine undergraduates and general practice undergraduates from Grade 2010 and 2009, Faculty of Naval Medicine, Second Military Medical University attended naval hygiene teaching. PBL and LBL approaches were applied in PBL group (Grade 2010, n=117) and LBL group (Grade 2009, n=140), respectively. The learning outcomes were evaluated by three tests covering PBL evaluation (or usually performance), theoretical examination and experimental practice . Questionnaire was used to investigate the recognition of PBL teaching method and new evaluation system. Data were analyzed by SPSS 16.0 and t test was used to compare the average scores of theory,α=0.05. Results The results showed that the average theory scores of Grade 2010 (78.51±7.57 and 71.68±5.74) were higher than those of Grade 2009 (65.36±6.41 and 59.97±7.08) (P=0.000, P=0.000). The questionnaire surveys indicated that more than 85% students in PBL group considered the PBL teaching method could enhance professional and comprehensive quali-ties, and that 84%students were satisfied with new evaluation system. Conclusions PBL showed better learning results than traditional methods in naval hygiene teaching and could better promoted students' comprehensive ability.

Changes of cognitive impairment and cerebral perfusion in patients with asymptomatic severe unilateral internal carotid stenosis / 中国脑血管病杂志

Objective To investigate the relationship between the evaluation of cerebral perfusion with CT perfusion (CTP)imaging and cognitive impairment in patients with asymptomatic severe internal carotid stenosis. Methods A total of 104 patients with asymptomatic severe unilateral internal carotid artery origin stenosis (the unilateral stenosis rate ≥70% and the contralateral stenosis rate 0. 05). The CTP parameters rMTT,rTTP,rCBV,and rCBF in the non-cognitive impairment group were 1. 074 ± 0. 066,1. 103 ± 0. 032,1. 045 ± 0. 021 and 1. 066 ± 0. 040,respectively;the CTP parameters rMTT,rTTP,rCBV,and rCBF in the cognitive impairment group were 1. 241 ± 0. 169, 1. 328 ± 0. 248,1. 046 ± 0. 030,and 1. 093 ± 0. 058,respectively. The rTTP and rMTT of the cognitive impairment were longer than those of the non-cognitive impairment group. There were significant differences in rTTP and rMTT between the 2 groups (P 0.05). Conclusion Most of the patients with asymptomatic severe internal carotid stenosis has cognitive impairment,and cerebral perfusion caused by stenosis is significantly slower in patients with cognitive impairment than in those with noncognitive impairment.

Correlation between endothelin receptor type A gene polymorphism and sporadic intracranial aneurysms / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the relationship between the 3 polymorphic loci of endothelin receptor type A (EDNRA) gene and intracranial aneurysms.</p><p><b>METHODS</b>Three EDNRA gene polymorphisms (rs5335, rs6842241, and rs6841581) were genotyped using polymerase chain reaction-restriction fragment length polymorphism analysis. The genotype and allele frequencies were calculated in the patients and the control group to analyze the association between the gene and the size of aneurysms.</p><p><b>RESULTS</b>No significant difference was found in the distribution of the EDNRA gene genotypes or allele frequencies between the patients and the control subjects. Only GG genotype of rs6841581 was found to significantly correlate with the size of aneurysms.</p><p><b>CONCLUSION</b>EDNRA gene rs6841581 has significant associations with the size of intracranial aneurysms, indicating a possible role of EDNRA in the genetic mechanisms of intracranial aneurysms and subarachnoid hemorrhage.</p>

Association of G-894T and T-786C polymorphisms of endothelial nitric oxide synthase gene with sporadic intracranial aneurysms / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the relationship between 2 polymorphic loci (G-894T and T-786C) of endothelial nitric oxide synthase (eNOS) gene and sporadic intracranial aneurysms.</p><p><b>METHODS</b>Two eNOS gene polymorphisms at G-894T and T-786C were genotyped using polymerase chain reaction-restriction fragment length polymorphism analysis. The genotype and allele frequencies were calculated for the patients and the control group and the association between the gene polymorphisms and the size of aneurysms was analyzed.</p><p><b>RESULTS</b>Significant differences were found in the genotype distribution for eNOS G-894T polymorphism between the patient and control groups. The GG genotype was associated with a higher risk of intracranial aneurysm than GT+TT genotype (OR:1.897, 95%CI: 1.023-3.519, P=0.04). The patients with intracranial aneurysms had a significantly higher eNOS T-786C C allele frequency than the control group. The C allele was associated with a higher risk of intracranial aneurysm than T allele (OR: 2.116, 95%CI: 1.073-4.151, P=0.030). No significant association was found between the eNOS polymorphisms and the size of aneurysms.</p><p><b>CONCLUSION</b>eNOS gene may be involved in the occurrence and development of intracranial aneurysms.</p>

Application of designed experiment teaching reform in naval hygiene project for military medical-training / 中华医学教育探索杂志

Designed experiment teaching fits well with characteristic of naval hygiene training subjects on the sea.Attention should be paid to several key points including content selection,training plan design and teaching effect evaluation.It was proved that designed experiments enhanced the practical ability of the undergraduates and significantly improved the effect of naval hygiene training subjects.

The practice and meditation of problem based learning in preventive medicine teaching for military foreign students / 中华医学教育探索杂志

Problem—based Learning(PBL) fit well with characteristic of military foreign medical students and the peculiarity of preventive medicine.In order to improve the self-studying and problem-solving ability of foreign students,attention should be paid to several key points to PBL,such as teaching content selection,informationization teaching tool application and teacher cultivation etc.

CHANGES OF FREE AMINO ACIDS IN PLASMA AND BRAIN OF RATS DURING SIMULATED SEA SICKNESS AND POST-ADAPTATION / 营养学报

Objective: To observe the changes of free amino acids (FAAs) in plasma and brain of rats during simulated sea sickness and post–adaptation. Method: Pica or kaolin consumption was used as an indicator to judge the development of sea sickness and adaptation when SD rats were stimulated by Crampton sea sickness simulator. FAAs concentrations in plasma and brain of rats were determined by high performance liquid chromatography (HPLC) after simulated sea sickness and post-adaptation. Results: After simulated sea sickness stimulation for 1 d, the levels of Cys and Ile were increased, and Gly and Pro decreased significantly in plasma. The increase of BCAA/AAA ratio was also found. In brain, the contents of Ala, Cys+Met, Tyr, His, and total amino acids were remarkably decreased. After simulated sea sickness stimulation for 21 d, no changes of FAAs were observed in plasma and brain but the ratio of Glu/ GABA was increased in brain. There were no differences of FAAs, Glu/GABA ratio and BCAA/AAA ratio in plasma and brain of tolerant and susceptible sea sickness rats. Conclusion: The levels of amino acids, especially those related to neurotransmitter synthesis, in plasma and brain were changed significantly during sea sickness.

Initial comparison of intracranial aneurysm embolization with mechanical detachable spirals and with Guglielmi detachable coils / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To compare the embolization effects of intracranial aneurysm with mechanical detachable spirals (MDS) and with Guglielmi detachable coils (GDC).</p><p><b>METHODS</b>One hundred and twenty cases with 125 intracranial aneurysms were embolized in Beijing Hospital from March 1995 to July 1999. Sixty-six aneurysms in 64 cases were embolised with MDS, 51 in 48 with GDC, and 8 in 8 with both MDS and GDC. Clinical data including sex, age, subarachnoid hemorrhage (SAH), Hunt & Hess grading, diameter and neck width of aneurysms, number and length of coils used per aneurysm, occlusive ratio, and complications were compared between MDS and GDC groups.</p><p><b>RESULTS</b>MDS and GDC group were comparable (t-test or chi2-test, all P value > 0.10) in terms of age, sex, diameter of aneurysms [(8.46 +/- 3.42) mm vs. (7.38 +/- 3.45) mm], neck width [(3.49 +/- 1.50) mm vs. (3.26 +/- 1.52) mm], coils number [(4.65 +/- 3.01) vs. (4.24 +/- 2.65)] and their length [(460.2 +/- 398.5) mm vs. (422.9 +/- 387.1) mm] used per aneurysm, occlusive ratio in aneurysms embolized > or = 80% [(95.00% +/- 6.32%) vs. (94.19% +/- 7.63%)], mortality and permanent complications (7.8% vs. 4.2%).</p><p><b>CONCLUSIONS</b>MDS and GDC are all materials for embolization of intracranial aneurysms. MDS is less expensive, but more difficult to control and of propensity to complications while GDC is more compliant, easier to be used, safer, and have many alternative types for use as well a more extensive indications.</p>