卒中后认知障碍与软脑膜侧支循环的代偿程度及静脉溶栓治疗的相关性分析

目的：比较急性缺血性卒中患者卒中后认知障碍的发生与软脑膜侧支循环的代偿程度及是否接受静脉溶栓治疗的相关性。方法：前瞻性收集2019年1月至2021年3月在石河子市人民医院住院的急性前循环脑梗死患者161例，获取患者入院时人口学资料，包括是否溶栓、性别、合并症等；通过蒙特利尔认知评估量表（Montreal cognitive assessment,MoCA）评分、简易精神状态检查量表（mini mental state examination,MMSE）评分评估患者认知功能；入院时美国国立卫生院卒中量表（National Institute of Health Stroke Scale,NIHSS）评分获取患者神经功能缺损症状；通过Blessed行为量表（Blessed behavior scale,BBS）评分评估患者的日常生活能力；通过区域软脑膜评分（regional leptomeningeal collateral score,rLMC）获取患者软脑膜侧支循环；根据卒中后6个月是否合并认知障碍分为认知障碍组和非认知障碍组，采用logistic多因素回归方法进行统计比较，分析2组患...     

超声及应变式弹性成像预测超声引导下腘静脉置入血管鞘用于治疗下肢深静脉血栓形成成功与否

目的 分析超声及应变式弹性成像预测超声引导下置入腘静脉血管鞘治疗下肢深静脉血栓形成(DVT)成功与否的价值。方法 回顾性分析103例接受超声引导下置入患侧腘静脉血管鞘的DVT患者的术前超声资料,比较置入血管鞘失败与成功病例腘静脉超声及应变式弹性成像表现差异;绘制差异有统计学意义超声参数的受试者工作特征曲线,获得其预测血管鞘置入失败的阈值,对每个参数阈值赋值1分,得到联合超声评分,以实际置入结果为标准,评价超声单一参数及联合评分的预测效能。结果 103例中,对100例行单侧、3例行双侧腘静脉置入血管鞘,包括左侧腘静脉71支、右侧35支,共106支腘静脉;对其中95支腘静脉置入血管鞘成功(成功组),11支失败(失败组)。相比成功组,失败组腘静脉内径及腘静脉与腘动脉内径比值均较小,血栓为等或高回声,与血管壁边界模糊,腘静脉应变式弹性评分为硬。以超声单一参数及联合评分预测置入血管鞘成功与否的曲线下面积分别为0.909、0.926、0.865、0.899、0.958及0.940(P均＜0.001)。结论 患侧腘静脉超声及应变式弹性成像能有效预测对下肢DVT患者行超声引导下置入腘静脉血管鞘成功与否。     

大剂量静脉滴注免疫球蛋白治疗系统性红斑狼疮的疗效

目的探讨大剂量静脉滴注免疫球蛋白治疗系统性红斑狼疮的疗效。方法选取2015年12月～2018年12月在我院收治的系统性红斑狼疮患者100例,将其随机分为对照组与观察组,每组50例,对照组采用环磷酰胺静脉滴注、强的松口服、甲基强的松龙冲击治疗。观察组在对照组治疗的基础上,使用大剂量静脉滴注免疫球蛋白治疗。比较两组患者的治疗效果。结果观察组患者血小板达高峰平均时间,明显短于对照组,差异有统计学意义(P0.05)。治疗前,两组患者系统性红斑狼疮疾病活动度评分(SLEDAI)、系统性红斑狼疮生活质量量表(SLEQOL)评分比较,差异无统计学意义(P0.05)。治疗后,观察组患者的SLE-QOL评分、SLEDAI评分明显低于对照组,差异有统计学意义(P0.05)。观察组患者4周内血小板上50%以上的为100%,明显高于对照组的76%,差异有统计学意义(P0.05)。两组不良反应发生情况比较无明显差异(P0.05)。结论大剂量静脉滴注免疫球蛋白对系统性红斑狼疮的治疗有积极的作用,能够控制疾病活动度,提高患者的生活质量,不会增加不良反应。     

丹红注射液对急性心肌梗死PCI围手术期心功能和TIMI血流影响的Meta分析

目的:系统评价丹红注射液对急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)围手术期心功能和心肌梗塞溶栓治疗(TIMI)血流分级的影响。方法:计算机检索CNKI,万方数据库,维普数据库,Pub Med,CBM,Web of Science,The Cochrane Library共7个数据库,全面采集在PCI围手术期应用丹红注射液治疗急性心梗的临床试验,采用Cochrane风险评价表进行文献质量评价,运用Revman 5.3软件进行Meta分析。结果:共纳入12个临床试验,包含1131例患者,其中丹红治疗组569例,对照组562例,结果显示在常规治疗的基础上加入丹红注射液治疗,患者的左室射血分数明显增高[均数差(MD)=6.62,95%可信区间(CI)(4.91,8.34),P<0.00001],TIMI分级3级患者明显增多[相对危险度(RR)=0.22,95%CI(0.12,0.41),P<0.00001],脑利钠肽水平明显降低[MD=-151.86,95%CI(-247.00,-56.72),P=0.002]。结论:丹红注射液可以提高急性心梗PCI围手术期心功能和增加TIMI血流的分级。     

Acute Ischemic Stroke Therapy in Infective Endocarditis: Case Series and Systematic Review

Objectives: To evaluate the safety of acute ischemic stroke (AIS) therapy in patients with infective endocarditis (IE) with intravenous thrombolysis (IVT) or endovascular therapy (EVT) such as mechanical thrombectomy. Methods: We conducted a retrospective study of patients who underwent AIS therapy with IVT or EVT at a tertiary referral center from 2013 to 2017, that were later diagnosed with acute IE as the causative mechanism. We then performed a systematic review of reports of acute ischemic reperfusion therapy in IE since 1995 for their success rates in terms of neurological outcome, and mortality, and their risk of hemorrhagic complication. Results: In the retrospective portion, 8 participants met criteria, of whom 4 received IVT and 4 received EVT. Through systematic review, 24 publications of 32 participants met criteria. Combined, a total of 40 participants were analyzed: 18 received IVT alone, 1 received combined IVT plus EVT, and 21 received EVT alone. IVT compared to EVT were similar in rates of good neurologic outcomes (58% versus 76%, P= .22) and mortality (21% versus 19%, P= .87), but had higher post-therapy intracranial hemorrhage (63% versus 18% [P= .006]). Conclusion: IV thrombolysis has a higher rate of post-therapy intracranial hemorrhage compared to EVT. EVT should be considered as first-line AIS therapy for patients with known, or suspected, IE who present with a large vessel occlusion.     

Correspondence between lung function and symptom measures from the Cystic Fibrosis Respiratory Symptom Diary–Chronic Respiratory Infection Symptom Score (CFRSD-CRISS)

BackgroundPulmonary exacerbations (PEx) in cystic fibrosis (CF) patients reduce quality of life. Lung function, measured by the percent predicted forced expiratory volume in 1 s (ppFEV1), is widely used to evaluate PEx treatments. We analyzed the correspondence of ppFEV1 with 8 patient-reported symptom-based questions from the Cystic Fibrosis Respiratory Symptom Diary–Chronic Respiratory Infection Symptom Score (CFRSD-CRISS).MethodsData were derived from the observational Standardized Treatment of Pulmonary Exacerbations (STOP) study. CF patients who had CFRSD-CRISS and ppFEV1 measurements on ≥2 timepoints were included: 1) day of initial PEx, 2) 7 days later, and/or 3) end of PEx. We calculated age-stratified Spearman correlation coefficients and 95% confidence intervals (95% CIs) between the change in ppFEV1 and change in CFRSD-CRISS items from index to day 7 and from index to the end of PEx treatment.ResultsLung function and symptom scores improved by the end of treatment; however, correlations between ppFEV1 and the specific CFRSD-CRISS measures were mostly weak to moderate. An exception was that among patients <18, we observed moderately strong correlations between changes in ppFEV1 and cough severity (r = ?0.58 (95% CI: ?0.80, ?0.21)), mucus quantity (r = ?0.51 (?0.77, ?0.11)), and wheezing (r = ?0.53 (?0.78, ?0.14)) from index until end of treatment.ConclusionsAs novel treatments are developed for PEx, it is important to ensure that improvement is measured meaningfully. The generally weak associations between patient-reported symptoms and ppFEV1 that we found suggest that these measures capture different aspects of the disease and both metrics are important when evaluating new treatments.