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Objective:To investigate the correlation between serum uric acid to albumin ratio (UAR) and large-artery atherosclerosis (LAA), its severity and short-term outcome.Methods:Patients with acute ischemic stroke admitted to the Department of Neurology, the Affiliated Hospital of Qingdao University from September 2017 to August 2022 were retrospectively enrolled. They were classified into LAA and non-LAA according to the TOAST etiological criteria. Patients with LAA were further divided into mild stroke group (≤8) and moderate to severe stroke group (>8) according to the National Institutes of Health Stroke Scale score at admission, and good outcome group (≤2) and poor outcome group (>2) according to the modified Rankin Scale score at discharge. Multivariate logistic regression analysis was used to determine the correlation between UAR and LAA, its severity and short-term outcome. The predictive value of UAR for poor outcomes in patients with LAA was evaluated by receiver operating characteristic (ROC) curve. Results:A total of 4 178 patients with acute ischemic stroke were enrolled, including 2 751 males (65.8%), aged 61.95±10.73 years. There were 2 000 (47.9%) patients with LAA, including 1 112 (55.6%) mild stroke and 888 (44.4%) moderate to severe stroke; 813 (40.65%) had good short-term outcomes and 1 187 (59.35%) had poor outcomes. UAR in the LAA group was significantly higher than that in the non-LAA group ( P<0.05). In patients with LAA, the UAR of the moderate to severe stroke group and the short-term poor outcome group were significantly higher than that of the mild stroke group and the short-term good outcome group, respectively (all P<0.05). Multivariate logistic regression analysis showed that the UAR was an independent risk factor for LAA (odds ratio [ OR] 1.043, 95% confidence interval [ CI] 1.016-1.071; P=0.002), its severity ( OR 2.000, 95% CI 1.860-2.151; P<0.001), and short-term poor outcomes ( OR 1.456, 95% CI 1.379-1.537; P<0.001). ROC curve analysis showed that the area under the curve of UAR for predicting short-term poor outcomes in patients with LAA was 0.727 (95% CI 0.704-0.750; P<0.001). The optimal cutoff value was 6.62, and the sensitivity and specificity were 86.6% and 56.7%, respectively. The area under the curve of UAR for predicting short-term poor outcomes in patients with LAA was greater than that predicted solely by uric acid and albumin. Conclusions:UAR is associated with LAA, its severity and poor prognosis, and has higher predictive value for poor outcomes in patients with LAA.
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Objective:To explore the correlation between intraoperative cooling temperature and postoperative neurological prognosis in aortic arch surgery.Methods:We observed and collected data from 118 patients who underwent open arch replacement surgery by a single surgeon with mild-to-moderate hypothermic circulatory arrest, from January 2017 to December 2020, in Beijing Anzhen Hospital. According to the bladder temperature during the circulation arrest, 118 patients were divided into 3 groups: T1 group[n=39, (25.58±0.64)℃]; T2 group[n=39, (28.21±0.77)℃]; T3 group[n=40, (30.95±0.97)℃]. Clinical data and operative data were analyzed to assess difference between these 3 groups. Analyze the risk factors of postoperative neurological complications, and explore further the correlation between intraoperative core temperature and postoperative neurological prognosis.Results:Among the 118 patients, the average operation, cardiopulmonary bypass (CPB), block, circulatory arrest, and selective cerebral perfusion (SCP) time were 6.64 h, 188.5 min, 104.19 min, 23.93 min, 28.81 min, respectively. The in-hospital death occurred in 8 patients(6.78%), and permanent neurological dysfunction (PND) in 13 patients(11.02%), transient neurological dysfunction (TND) in 25 patients(21.19%). There was no significant difference in the deaths among the three groups. The incidence of TND and PND in the T3 group was significantly reduced ( P=0.042; P=0.045). In addition, the volume of drainage during the first 24 h and the incidence of re-exploration for bleeding had a relatively obvious decreasing trend ( P=0.005; P=0.012). Through multiple regression analysis, under the adjusted model, the core temperature was independently correlated with the incidence of postoperative PND ( OR=0.51; 95% CI: 0.27-0.97; P=0.0389); in group comparison, the relatively higher core temperature was an independent protective factor for postoperative PND ( OR=0.04; 95% CI: 0.00-0.91; P=0.0434). Conclusion:Our research had preliminary proved that in the open arch replacement surgery, mild hypothermia can reduce the incidence of some complications of deep hypothermia, at the same time improve the prognosis of the neurological prognosis, reduce the incidence of postoperative PND.
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Objective:To investigate the predictive value of the National Institutes of Health Stroke Scale (NIHSS) score at baseline and 24 h after the onset for the outcomes after endovascular mechanical thrombectomy (EMT) in patients with acute ischemic stroke.Methods:Patients with anterior circulation large vessel occlusive acute ischemic stroke received EMT in the Affiliated Hospital of Qingdao University from July 2018 to June 2020 were enrolled prospectively. According to the modified Rankin Scale scores at 3 months after the onset, they were divided into good outcome group (0-2) and poor outcome group (3-6). The demographic and clinical data between the groups were compared. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcomes. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the independent influencing factors for outcomes. Results:A total of 124 patients were included. Their age was 65.23±12.40 years, 80 were males (64.5%). The baseline NIHSS score was 15 (interquartile range, 11-19). Seventy-two patients (58.1%) had a good outcome and 52 (41.9%) had a poor outcome. Univariate analysis showed that there were significant differences in age, degree of vascular recanalization, baseline and 24 h NIHSS score after onset, and whether having intracranial hemorrhage or not between the good outcome group and the poor outcome group ( P<0.05). Multivariate logistic regression analysis showed that there was a significant independent correlation between the NIHSS score at 24 h after onset and the poor outcome (odds ratio [ OR] 1.243, 95% confidence interval [ CI] 1.125-1.373; P<0.001). ROC curve analysis showed that the area under the curve of poor outcome predicted by baseline NIHSS score was 0.639 (95% CI 0.542-0.737), and the predictive sensitivity and specificity were 80.8% and 45.8% respectively. The area under the curve of poor outcome predicted by NIHSS score at 24 h after onset was 0.830 (95% CI 0.759-0.902), and the predictive sensitivity and specificity were 94.2% and 65.3% respectively. Conclusion:In patients with anterior circulation large vessel occlusive acute ischemic stroke receiving EMT, the NIHSS score at 24 h after onset has higher predictive value for poor outcomes at 3 months after onset, and is significantly better than the baseline NIHSS score.
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Objective:To investigate the relationship between serum transferrin(TRF)and the characteristics and prognosis of elderly patients with sepsis.Methods:A retrospective analysis was conducted on 49 elderly patients with sepsis treated at the Department of Critical Medicine and the Department of Respiratory and Critical Medicine of the First Affiliated Hospital of Suzhou University between October 2020 and March 2022 who had met the inclusion criteria.These patients were divided into a shock group(n=18)and a non-shock group(n=31); Based on outcomes, they were also divided into a death group(n=16)and a survival group(n=33).Through the random number table method, 30 healthy elderly people from the physical examination center of our hospital were selected as the control group.TRF and ferritin(SF)were measured on the 1st, 3rd and 7th day after admission, and the correlation between TRF and the sequential organ failure assessment score(SOFA)was analyzed.The predictive value of TRF on prognosis was evaluated via the receiver operating characteristic curve.Finally, the influence of multiple factors on prognosis was analyzed using the binary logistic regression model.Results:Compared with the control group at admission, SF levels of elderly patients with sepsis increased[709.20(402.40, 2000.00)μg/L vs.102.05(79.55, 199.75)μg/L, Z=-5.482, P<0.01], but TRF levels decreased[1.43(1.12, 1.72)g/L vs.2.23(1.80, 3.12)g/L, Z=5.395, all P<0.01], with statistical significance.On the 3rd and 7th day, TRF levels in the shock group were lower than in the non-shock group[(1.25±0.35)g/L vs.(1.55 ±0.51)g/L, 1.15(9.68, 1.34)g/L vs.1.56(1.19, 2.03)g/L]( t=-2.186, Z=3.258, P<0.05).There was a linear correlation between TRF and SOFA score on the 1st, 3rd and 7th day( R2=0.177, 0.176, 0.275, all P<0.01).TRF levels in the death group were lower than in the survival group on the 3rd and 7th day( Z=2.208, 3.423, P<0.05 for both).TRF levels on the 3rd and 7th day in elderly patients with sepsis had predictive value in evaluating the prognosis[area under receiver operating characteristic curve( AUC)values=0.696, 0.804, P<0.05, P<0.01].The survival curves based upon the best cutoff values(TRF=1.085 g/L on the 3rd day, TRF=1.330 g/L on the 7th day)between the two groups were statistically significantly( χ2=10.903, 13.318, P<0.01 for both).With TRF<1.085 g/L on the 3rd day, the risk of death in elderly patients with sepsis on the 28th day was 9.388 times the usual risk( OR=9.388, P<0.01), and with TRF<1.330 g/L on the 7th day, the risk of death was 14.625 times the usual risk on the 28th day( OR=14.625, P<0.01). Conclusions:Increased SF in elderly patients with sepsis is not related to disease severity, but the level of TRF is related to disease severity, and the level of TRF on the 3rd and 7th day is related to the prognosis and is an independent risk factor for all-cause death on the 28th day.
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Total thoracoabdominal aortic aneurysmrepair is one of the most complex operations in cardiac surgery. Patients may have spinal cord injury, disturbance of consciousness, hypoxemia, arrhythmia, acute renal injury, abdominal organ ischemia and so on after operation. Postoperative complications may occur in patients with neurological, respiratory, circulatory, digestive, urinary and coagulation systems. This paper summarizes the experience of prevention and treatment of postoperative complications based on the medical literature at home and abroad and the experience of diagnosis and therapeutic schedule in our hospital, in order to improve the prognosis.
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As one of the leucine-rich repeat protein family members, leucine-rich α-2 glycoprotein 1 (LRG1) affects many diseases by transforming growth factor (TGF)-β signaling pathway, and is closely associated with angiogenesis, endothelial cell apoptosis and autophagy, inflammatory reaction and blood-brain barrier damage after cerebral ischemia. It is expected to become a new marker and therapeutic target of ischemic stroke. However, at present, there are few studies on investigating the relationship between LRG1 and ischemic stroke, and the understanding of its molecular mechanism is not yet complete, resulting in controversy about the role of LRG1 in ischemic stroke. Therefore, this article reviews the research progress of LRG1-TGF-β signaling pathway and ischemic stroke, hoping to provide new ideas for the early diagnosis, prevention and treatment of ischemic stroke.
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Objective:To explore the application of cannulating the ischemic femoral and right axillary artery in Sun’s procedure for acute type A aortic dissection with lower extremity ischemia.Methods:Twelve patients of acute Stanford type A aortic dissection complicated by lower extremity ischemia were analyzed retrospectively between July 2017 and May 2019, and the right axillary and ischemic femoral artery were used for cardiopulmonary bypass. All the 12 patients were male and categorized as the complicated Stanford type A aortic dissection. The mean age was(48.4±8.4)years, and the median time from symptom onset to emergency operation was 24.00(18.50, 43.25)hours. Eleven patients presented with unilateral extremity ischemia, while bilateral extremity ischemia occurred in one. The prosthetic vessel, with a diameter of 8 mm, was anastomosed to the ischemic femoral artery via an end-to-side way. Both the right axillary artery and the prosthetic vessel were cannulated for CPB. For the proximal dissection in this cohort of patients, we performed Bentall procedure in 5 cases, ascending aortic replacement in 3, and the aortic valve commissure reconstruction with ascending aortic replacement in 4. Total arch replacement with stented elephant trunk implantation were carried out for arch and descending aortic lesion in 12 cases.Results:Early mortality was 8.3%(1/12). The time of CPB, aortic clamp, circulatory arrest, and selective cerebral perfusion averaged(204.6±26.3) min, (114.6±16.6) min, (23.4±8.5) min, and(33.5±11.0) min, respectively. Five patients underwent concomitant bypass procedures, including: ascending aorta-bilateral femoral artery bypass in 1, ascending aorta-right femoral artery bypass in 3, ascending aorta-left femoral artery bypass in 1. Acute renal failure with continuous renal replacement therapy occurred in 4 cases, re-thoratomy for hemaostsis in 1, and re-intubation in 1. One patient developed osteofascial compartment syndrome after aortic repair, and consequent left lower extremity compartment fasciotomy was performed. The mean follow-up time was(17.2±7.6)months, and no aortic-related adverse event was detected during follow up.Conclusion:To acute Stanford type A aortic dissection with lower extremity ischemia, cannulating the ischemic femoral and right axillary artery in Sun’s procedure were associated with lower perioperative mortality and better prognosis.
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Objective:To evaluate the application of moderate hypothermia circulatory arrest(MHCA)with a higher temperature(29℃) and bilateral selective antegrade cerebral perfusion(bSACP) in acute Stanford type A aortic dissection(TAAD] treated by total arch replacement with stented elephant trunk implantation.Methods:From July 2019 to January 2020, fifteen patients of acute TAAD undergoing emergent operations via MHCA with a core temperature of 29℃ and bSACP were analyzed retrospectively(modified group), and 26 patients treated by MHCA(25℃) and unilateral selective antegrade cerebral perfusion(uSACP) during the same period were defined as the traditional group. All cases were complicated type A dissection. The mean age in this cohort was 49 years, and 32 patients(78%) were male. Thirty six patients(87.8%) suffered from arterial hypertension. The proximal manipulations included: aortic sinus repair in 13 cases(31.7%), ascending aortic replacement in 29(70.7%), Bentall in 12(29.3%). Total arch replacement with stented elephant trunk implantation was performed in all cases.Results:The in-hospital death occurred in 2(4.9%), and cerebral infarction in 3(7.3%), transient neurologic deficit in 5(12.2%), paraplegia in 2(4.9%). The ratios of above-mentioned adverse events in the traditional and modified group were[2(7.7%) vs. 0, P=0.524], [3(11.5%)vs. 0, P=0.287], [4(15.4%) vs. 1(6.7%), P=0.636], [1(3.8%) vs. 1(6.7%), P=1.000] respectively. The major adverse events in the modified group were transient neurologic deficit and paraplegia in 1 each. Compared with the traditional group, the time of operation, CPB, cardiac arrest, circulatory arrest of the lower part, anterograde low flow cerebral perfusion, mechanical ventilation and ICU stay was shorter. The drainage of 48 hours after surgery was less also. The differences in new acute renal failure requiring CRRT and re-sternotomy for bleeding between groups were not statistical significance. Conclusion:The early results of MHCA(29℃) and bSACP applied in total arch replacement with stented elephant trunk implantation for acute TAAD were satisfactory. The time of mechanical ventilation and ICU stay was shorter in the modified group, and the drainage of 48 hours after surgery was less also.
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Objective To compare the clinical effects of ganciclovir combined with dexamethasone and ganciclovir alone in the treatment of acute idiopathic facial neuritis.Methods From March 2014 to March 2016,80 patients with acute idiopathic facial neuritis admitted in the department of neurology of Luzhong Hospital were randomly divided into treatment group and control group according to the admission sequence,with 40 cases in each group.The two groups were given basic treatment (mecobalamine intramuscular injection + clonazepam and continuous application for 15d),and the treatment group was excluded from the corticosteroid application.On this basis,ganciclovir combined with dexamethasone was applied in the treatment group,and ganciclovir was applied in the control group.Both two groups had a course of 15 days.All the patients were graded by Portmann simple scale before treatment and at 7 days and 15 days after treatment,and statistical significance of SPSS13.0 software was adopted.Results Intra-group comparison:after treatment of 7d,the score of the treatment group was (10.11 ± 3.62) points,which was significantly higher than (2.60 ± 2.22) points before treatment (t =1.432,P ＜ 0.05).The score had no statistically significant difference between 7d after treatment [(10.11 ± 3.62)points] and 15d after treatment [(11.82 ±3.02) points] in the treatment group (t =1.582,P ＞ 0.05).In the control group,the score had no statistically significant difference between 7 d after treatment [(3.22 ± 3.12) points] and before treatment [(2.70 ± 2.30) points](t =0.923,P ＞0.05).Comparison between the two groups:there was no statistically significant difference in pretreatment score between the two groups (P ＞ 0.05).The score of the treatment group at 7d after treatment [(10.11 ±3.62) points] was significantly different from that of the control group[(3.22 ± 3.12)points] (t =1.633,P ＜ 0.05).There was no statistically significant difference in scores between the two groups at 15d after treatment (P ＞ 0.05).Conclusion Ganciclovir combined with dexamethasone and ganciclovir alone are effective in the treatment of acute idiopathic facial neuritis.Although the improvement effect of the combined treatment is earlier than that of single use,there is no significant difference in the total effective rate between the two treatments.
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Objective@#To compare the clinical effects of ganciclovir combined with dexamethasone and ganciclovir alone in the treatment of acute idiopathic facial neuritis.@*Methods@#From March 2014 to March 2016, 80 patients with acute idiopathic facial neuritis admitted in the department of neurology of Luzhong Hospital were randomly divided into treatment group and control group according to the admission sequence, with 40 cases in each group.The two groups were given basic treatment (mecobalamine intramuscular injection + clonazepam and continuous application for 15d), and the treatment group was excluded from the corticosteroid application.On this basis, ganciclovir combined with dexamethasone was applied in the treatment group, and ganciclovir was applied in the control group.Both two groups had a course of 15 days.All the patients were graded by Portmann simple scale before treatment and at 7 days and 15 days after treatment, and statistical significance of SPSS13.0 software was adopted.@*Results@#Intra-group comparison: after treatment of 7d, the score of the treatment group was (10.11±3.62)points, which was significantly higher than (2.60±2.22)points before treatment(t=1.432, P<0.05). The score had no statistically significant difference between 7d after treatment[(10.11±3.62)points] and 15d after treatment[(11.82±3.02)points] in the treatment group (t=1.582, P>0.05). In the control group, the score had no statistically significant difference between 7d after treatment[(3.22±3.12)points] and before treatment[(2.70±2.30)points] (t=0.923, P>0.05). Comparison between the two groups: there was no statistically significant difference in pre-treatment score between the two groups (P>0.05). The score of the treatment group at 7d after treatment[(10.11±3.62)points] was significantly different from that of the control group[(3.22±3.12)points](t=1.633, P<0.05). There was no statistically significant difference in scores between the two groups at 15d after treatment (P>0.05).@*Conclusion@#Ganciclovir combined with dexamethasone and ganciclovir alone are effective in the treatment of acute idiopathic facial neuritis.Although the improvement effect of the combined treatment is earlier than that of single use, there is no significant difference in the total effective rate between the two treatments.