Severe COVID-19 patients with liver injury: a seven-case series.

We present the case details of seven patients diagnosed with severe novel coronavirus disease 2019 (2019-nCoV, hereafter COVID-19) with hepatic injury. Most of these patients were elderly and had hypertension, diabetes mellitus, coronary heart disease, and other underlying health conditions prior to admission for COVID-19. Liver injury occurred in all seven cases during the course of the disease. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels initially increased (1.2-times to 2.0-times the normal value, respectively) in the second week. The liver function recovered in all patients within one week of conventional liver protection treatment. Elevated serum transaminase levels in these patients were due to the COVID-19 infection but could also be related to systemic immune response caused by cytokine storm syndrome (CSS) and hepatocyte damage caused by ischemia and hypoxia. COVID-19 is highly infectious and mainly affects the lungs. In some cases, especially in patients with severe disease type, COVID-19 may also cause liver injury. The liver function of patients with severe COVID-19 should be very carefully monitored, especially if the patients are elderly and have underlying comorbidities.

Analysis of related factors of orolingual angioedema after rt-PA intravenous thrombolytic therapy.

OBJECTIVE: Orolingual angioedema (OA) is a rare clinical complication with a potentially fatal risk that occurs after the intravenous application of alteplase (rt-PA) in patients with acute ischemic stroke. The purpose of this work is to investigate the related factors of OA in patients with acute ischemic stroke after the administration of intravenous thrombolytic therapy, to improve the predictive ability of OA during intravenous thrombolytic therapy, and to reduce the prevalence of complications. PATIENTS AND METHODS: We recruited 1223 cases of patients with acute ischemic stroke that were treated in the Department of Neurology No. 4 of the Tianjin Huanhu Hospital from June 2014 to April 2015. The clinical manifestations of rt-PA related OA were recorded, the clinical prevalence was counted, related factors of OA after intravenous thrombolytic therapy were analyzed, and the risk assessment of rt-PA related OA was conducted. RESULTS: 14 cases of patients developed OA, with a prevalence rate of 1.14%. Among them, 5 had a history of urticaria, 4 of drug allergy, and 3 of food allergy. Among the 14 cases of patients, 10 developed OA in the process of intravenous thrombolysis and 4 after intravenous thrombolysis, 12 showed lip edema, 9 showed extensive swelling of tongue, 3 showed swelling of lateral tongue, 3 were complicated by respiratory distress, 10 showed infarction in the middle cerebral artery territory, and 6 had previously been given oral ACEI drugs. CONCLUSIONS: Orolingual angioedema is a rare complication that occurs after rt-PA intravenous thrombolytic therapy; when serious, it may endanger a patient's life. If patients take an oral hypotension such as ACEI drugs before the onset of OA, they have a history of allergies, or the lesion is an infraction in the dominated area of the middle cerebral artery, the risk of OA after rt-PA intravenous thrombolytic therapy will be increased. The prevalence of OA should be monitored during the rt-PA intravenous thrombolytic therapy process; timely detection and early intervention should be conducted, which can avoid serious adverse consequences.

Observation of clinical efficacy of rt-PA intravenous thrombolytic treatment for patients combined with grade 0-1 diabetic foot by Wagner classification and acute ischemic stroke.

OBJECTIVE: To evaluate the safety and efficacy of rt-PA intravenous thrombolytic treatment for patients with diabetic foot (DF) and acute ischemic stroke. PATIENTS AND METHODS: A retrospective analysis was performed on 76 patients admitted between June 2012 to December 2015 presenting with acute ischemic stroke and Grade 0-1 DF a (Wagner classification). The treatment group consisted of 44 patients who received rt-PA intravenous thrombolytic treatment, while 32 cases in the control group did not. Both groups received monitored dietary therapy and hypoglycemic drugs to control their blood glucose levels. In the treatment group, patients received rt-PA intravenous thrombolytic treatment 4.5h after the onset of ischemic stroke. Physical parameters like color change of sick-foot skin, conditions of ulcer concrescence, changes of skin temperature, and promotion of pain scores were observed in both the groups. RESULTS: The improvement in the rt-PA intravenous thrombolytic treatment group was higher than that in general treatment group, and the difference between them had statistical significance (p<0.01). Though the improvement of foot symptoms of patients who received rt-PA intravenous thrombolytic was better than that of the control group; there was no obvious statistical difference in the incidence of adverse events between the treatment group and the control group. CONCLUSIONS: rt-PA can reduce the level serum fibrinogen, promotes local microcirculation and nutrition metabolism of diabetic foot, and improve the clinical prognosis of patients with diabetic foot, but will not increase the incidence of adverse events at the same time.

Safety and effectiveness of intravenous thrombolysis with recombinant tissue plasminogen activator in eighty years and older acute ischemic stroke patients.

OBJECTIVE: To explore the safety and efficacy of intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) in elderly (≥ 80 years old) acute ischemic stroke (AIS) patients. PATIENTS AND METHODS: The clinical data of patients who were treated in Tianjin Huanhu Hospital from June 2012 to November 2013 were retrospectively analyzed; amongst them 404 patients had received IVT with rt-PA and 200 patients had not received IVT. Among ≥ 80 years' old patients, 204 had received IVT and 200 had not. And, the 404 patients who had received IVT, they were divided into two subgroups: elderly (≥ 80 years of age; n = 204) and controls (< 80 years old; n = 200). The incidence of intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH), case-fatality rate, and other prognostic indicators were compared. RESULTS: Among all ≥ 80 years' old patients, the IVT subgroup had significantly superior good outcome rates than the non-IVT subgroup at 24-h and 3-month, along with significantly lower case-fatality rate. But for the patients those who had received IVT, the incidence of ICH and the 7-day case-fatality rate were not significantly increased in both the elderly and control subgroups. The 24-h and 3-month good outcome rates were not significantly different between these two subgroups as well. CONCLUSIONS: IVT with rt-PA is a safe and effective treatment for ≥ 80 year's old AIS patients.

Analysis on the correlation factors for hemorrhagic transformation after intravenous thrombolytic therapy.

OBJECTIVE: To examine the correlation factors for hemorrhagic transformation after intravenous thrombolytic therapy, so as to improve the forecast about hemorrhagic transformation in the process of thrombolysis, and provide theoretical basis for prognosis of the patients. PATIENTS AND METHODS: A total of 1223 patients with intravenous thrombolytic therapy including NIHSS score before intravenous thrombolytic therapy and MRS score by follow-up of three months after intravenous thrombolytic therapy were enrolled in this study, and related clinical data were collected. t test, χ2 test and logistic regression analysis were used to find the correlation factors for hemorrhagic transformation. RESULTS: Single-factor analysis found hypertension, diabetes mellitus, history of stroke and collateral circulation insufficiency had statistical significances between each type of hemorrhage group groups. Amongst of the history of hypertension, diabetes and stroke was correlation factor for prognosis. CONCLUSIONS: Intravenous thrombolysis hemorrhagic transformation associated with these factors including the vessel wall, blood composition and biochemical markers.

Study on the effect of urinary kallidinogenase after thrombolytic treatment for acute cerebral infarction.

OBJECTIVE: To evaluate the safety and efficacy of urinary kallidinogenase for recombinant tissue-type plasminogen activator (rt-PA) intravenous thrombolytic treatment in patients with acute cerebral infarction. PATIENTS AND METHODS: All 200 patients with acute cerebral infarction were randomized 1:1 into an experimental group (100 cases) and a control group (100 cases). Patients in the control group were administrated rt-PA (0/9 mg/kg) while patients in the experimental group were given urinary kallidinogenase by intravenous drip (0.15 PNAU/d, for 7 days) after rt-PA intravenous thrombolytic treatment (0.9 mg/kg). The main evaluation index was NIHSS and BI. RESULTS: Compared to the control group, the NIHSS scores were significantly lower 7 and 90 days after thrombolytic therapy (t = 2.391, 2.714; p < 0.05). BI scores were obviously higher at 90 days after thrombolytic therapy in the experimental group (t = 2.675, p < 0.05). CONCLUSIONS: Urinary kallidinogenase may improve the treatment effect for rt-PA intravenous thrombolytic treatment in patients with acute cerebral infraction.

Endovascular treatment of recurrent intracranial aneurysms with re-coiling or covered stents.

OBJECTIVE: To report our experiences in the treatment of recurrent intracranial aneurysms with re-coiling or covered stents. METHODS: A total of 291 patients with 305 intracranial aneurysms were treated with detachable coils, and 41 (28.9%) of 142 patients with aneurysms in the internal carotid artery had a recurrent aneurysm during the follow-up period. For this study, 31 recurrent aneurysms in 31 patients who had angiograms within 6 months following retreatment with detachable coils (group A, n = 20) or covered stents (group B, n = 11) were analysed. Aneurysms were categorised as complete or incomplete occlusion via angiographic assessment and graded as full recovery, improvement, no change or deterioration via clinical assessment. Data regarding technical success, initial and final angiographic results, mortality, morbidity and final clinical outcome were collected and analysed postoperatively. RESULTS: Coil embolisation and covered stent placement were technically successful in all recurrent aneurysms. The initial angiographic results showed complete occlusion in 11 patients (55%) in group A and in eight (72.7%) in group B (p = 0.452), and the final angiographic results exhibited complete occlusion in 10 patients (50%) in group A and in 11 (100%) in group B (p = 0.005). There were no significant differences in technique success, mortality, culminate morbidity or final clinical outcome between the two groups. CONCLUSIONS: Recurrent aneurysms after coiling can be successfully treated and occluded with re-coiling or covered stent placement. However, covered stents seem to be more effective than re-coiling with regard to complete occlusion of recurrent aneurysms.

Endovascular Treatment for Very Small Supraclinoid Aneurysms with Stent-Assisted Coiling. Long-Term Follow-up in Six Cases.

SUMMARY: The endovascular treatment of very small aneurysms (lesions less than 3 mm in maximum diameter) with wide necks remains a challenge for saccular embolization. We retrospectively analyzed our data using Neuroform stent-assisted coiling for very small supraclinoid aneurysms with wide neck to evaluate the feasibility and efficacy of endovascular treatment of these lesions. We conducted a review of our experience and results of endovascular treatments in six patients with seven very small aneurysms. All aneurysms were located at the side wall of the supraclinoid segment of the ICA. They were ruptured in two patients and unruptured in four. The technique of stent-assisted coiling was used in all cases with coiling before stenting and additional coils after deployment of the stent in the same session. All patients were successfully embolized with stent-assisted coiling. The coils were introduced into the lumen for subtotal occlusion in five aneurysms and for partial occlusion in two. During one to two years follow-up angiography, all aneurysms were completely occluded and no recurrence occurred. No complications were observed. Endovascular stent-assisted coil embolization of supraclinoid very small aneurysms with wide necks is effective and feasible. Subtotal aneurysm occlusion might progress to total occlusion.

The feasibility and efficacy of treatment with a Willis covered stent in recurrent intracranial aneurysms after coiling.

BACKGROUND AND PURPOSE: Aneurysm recurrence is an innate problem after coiling, and the recurrence rate is higher in complicated aneurysms. We evaluated the feasibility and efficacy of using the Willis covered stent in treating recurrent aneurysms after coil embolization. MATERIALS AND METHODS: Eight aneurysms in 8 patients treated with detachable coils had confirmed recurrent aneurysms: 3 giant, 1 large, 1 dissecting, and 3 small wide-necked. The recurrent aneurysms involved C3 in 1 patient, C4 in 1, C7 in 5, and V4 in 1. A total of 11 covered stents were implanted into 8 target arteries. Follow-up angiography was performed 1-16 months after the procedure. Clinical follow-up data were collected and retrospectively analyzed, grading as fully recovered, improved, unchanged, or aggravated. RESULTS: Willis covered stent placement succeeded technically in all of the aneurysms. No technique-related adverse event occurred. Total occlusion was achieved immediately in 6 aneurysms, and a small endoleak was observed in 2 aneurysms. No mortality or morbidity occurred during or after the procedures, including during the follow-up period. Follow-up angiograms revealed that all 8 of the recurrent aneurysms were completely isolated, and 8 parent vessels kept patency, except 1 with mild stenosis. Clinical neurologic symptoms fully resolved in 5 patients, improved in 1, and were unchanged in 2 at the end of the follow-up period. CONCLUSIONS: In this small study with a middle-term follow-up, the Willis covered stent was used safely and effectively to occlude recurred aneurysms after coiling. Longer-term follow-up and additional clinical experience are needed to fully determine the safety and efficacy of the device.