Application and efficacy of induced hypertension and hypotension in carotid endarterectomy / 中华普通外科杂志

Objective To evaluate the safety and efficacy of induced hypotension and hypotension in carotid endarterectomy (CEA).Methods Data of 1 486 patients who underwent CEA in multicenters from Aug 2012 to Aug 2018 were retrospectively analyzed.After screening,a total of 1 448 patients met the inclusion criteria.Induced hypertension and hypotension was used in all thees patients.Results 87.8％ of the patients were with severe carotid stenosis.The average operative time was (51.8 ± 6.1) min,and the internal carotid artery clamping time was (11.4 ± 3.1) min.After induced hypertension,the stump pressure were higher than that before,of which 1 438 (99.3％) were greater than 50 mmHg.Monitoring of EEG oxygen saturation showed that the value of ipsilateral rSO2 was significantly lower than that of the contralateral [(56％ ± 3％) vs.(64％ ± 4％),P ＜ 0.05] before induced hypertension.After induced hypertension and clamp removal,the value of ipsilateral rSO2 was lower than that of the contralateral,but there was not significant difference (all P ＞ 0.05).Perioperative cerebral infarction occurred in 2 cases,ipsilateral cerebral hemorrhage in 1 case,contralateral cerebral hemorrhage in 1 case and myocardial infarction in 2 cases.Connclusion The technique of induced hypotension and hypotension play a temporary role in brain protection for patients undergoing CEA.This study demonstrated the safety and effectiveness of induced hypertension and hypotension technique.

Protective effect of rhEPO on tight junctions of cerebral microvascular endothelial cells early following traumatic brain injury in rats.

OBJECTIVE: The goal of this study was to investigate the protective effect of recombinant human EPO(rhEPO) on cerebral microvascular endothelial cells and the mechanisms by which rhEPO interacts with TJs proteins, claudin-5, Occludin and ZO-1 during the early period following traumatic brain injury. RESEARCH DESIGN: Rats (n = 81) were randomly divided into sham-operated group, TBI group and rhEPO+TBI group. Traumatic brain injury was induced by the Marmarou method. METHODS AND PROCEDURES: Rats were killed at 3, 24, 72 and 168 hours after TBI. The integrity of the blood-brain barrier was investigated by using a spectrophotometer to assess extravasation of Evans blue dye. The expression of Claudin-5, Occludin and ZO-1 were determined by immunohistochemistry and real-time fluorescence quantitative PCR. RESULTS: From 3 hours to 3 days, rats in the TBI group demonstrated a remarkable increase in Evans blue content in the brain, relative to rats in the sham-operated group (p < 0.05). The expression of Claudin-5 and Occludin was significantly lower than those in the sham-operated group (p < 0.05). In contrast, rats in the TBI+rhEPO group demonstrated a significant decrease in brain levels. CONCLUSION: It was found that administration of rhEPO protected cerebral microvascular endothelial cells and reduced permeability of BBB and the mechanisms may be due to increasing the expression of TJs proteins.

Characteristics of Magnetic Resonance Imaging and Electroencephalogram in Patients with Alzheimer's Disease or Vascular Demen-tia / 中国康复理论与实践

Objective To compare the features of magnetic resonance imaging (MRI) and electroencephalogram (EEG) to differentiate Alzheimer's disease (AD) and vascular dementia (VD). Methods It was analyzed of the MRI and EEG from 39 patients with AD and 56 pa-tients with VD, to compare the proportion of cerebral atrophy, hippocampal atrophy and leukoaraiosis in MRI, and the proportion of the moderate to severe disorder of EEG and the power spectrum. Results The proportion of cerebral atrophy and hippocampal atrophy was more and leukoaraiosis was less in the AD group than those in the VD group. The proportion of the moderate to severe disorder of EEG increased in AD group, and the ratio of (θ+δ)/(α+β) of whole brain was more in the AD group than in the VD group (P<0.05). Conclusion It is more likely to be AD in dementia patients with atrophy without leukoaraiosis and cerebral ischemic lesions, especially for those with severe abnor-mal EEG.

Observation on the effect of artificial femoral head replacement surgery in the treatment of elderly patients with intertrochanteric fracture / 中国基层医药

ObjectiveTo investigate the effect of artificial femoral head replacement surgery in the treatment of elderly patients with intertrochanteric fracture.MethodsThere were 120 cases with intertrochanteric fracture according to the different surgical procedures,they were divided into the observation group with 60 cases and the control group of 60 cases.The observation group were taken hemiarthroplasty.The control group were taken dynamic hip fixation.The situations for the two groups of patients after surgery were compared.ResultsThe observation group:the blood loss was (413.6 ± 125.2) ml,operative time was (65.2 ± 9.8 ) min,ambulation time was (5.9 ± 2.3 ) d,length of stay was ( 15.6 ± 2.6 ) d,complication rate was 11.7 ％.The control group:blood loss was (440.5 ± 126.3 ) ml,operative time was (81.2 ± 12.1 ) min,ambulation time was ( 16.4 ± 4.2) d,length of stay was (25.7 ± 3.1 ) d,complication rate was 33.3％.The blood loss,operative time was not different between two groups.The ambulation time,hospital stay,complication rate were significantly different.There were statistical significance ( P ＜ 0.05 ).ConclusionThe hemiarthroplasty was safe,patients with weight-bearing take exercise early,and bed time was short,had less complications,and could achieve satisfied clinical results,it should be widely applied.

Long-term prognostic value of N-terminal prosoma brain natriuretic peptide in patients with acute coronary syndrome / 中华老年医学杂志

Objective To explore the long-term predictive value of serum concentration of N-terminal prosoma brain natriuretic peptide (NT-proBNP) in the early acute coronary syndrome (ACS). Methods The 164 patients firstly hospitalized and finally diagnosed as acute myocardial infarction (AMI) were selected, and then the serum concentration of NT-proBNP was determined in less than 12 hours. According to the 75 percentage points of serum concentration of NT-proBNP, the patients were divided into two groups: low concentration group (n = 123) and high concentration group (n = 41 ). The major adverse cardiac events (MACEs) were followed and compared at one month, six months and twelve months between low group and high group. Results At 1-, 6-, 12-month follow-up, the odds ratio (OR) of death event were 4.1, 5.6 and 4.0 in high group respectively, and the nonfatal heart failure occurred in 4, 4 and 7 patients in high group. Multiple factor logistic regression analysis showed that NT-proBNP was an independent risk factor of the MACEs at different periods including short time, middle time and long time in ACS patients (P＜0. 05). Conclusions NT-proBNP is a strong predictor of the long-term MACEs in patients with early ACS.