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排序方式: 共有1143条查询结果,搜索用时 15 毫秒
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Mahmoud B. Malas Jose Ignacio Leal Lorenzo Besma Nejim Todd M. Hanover Manish Mehta Vikram Kashyap Christopher J. Kwolek Richard Cambria 《Journal of vascular surgery》2019,69(6):1786-1796
ObjectiveWe report the 1-year outcomes of the Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER) multicenter trial. This trial introduced a novel transcarotid neuroprotection system (NPS), the ENROUTE transcarotid NPS (Silk Road Medical Inc, Sunnyvale, Calif). Postoperative results demonstrated that the use of the ENROUTE transcarotid NPS is safe and effective. The aim of this study was to evaluate the safety of transcarotid artery revascularization (TCAR) and to present the 1-year outcomes.MethodsThis study is a prospective, single-arm clinical trial. Current enrollment occurs in 14 centers. Primary end points were incidence rates of ipsilateral stroke at 1 year after TCAR. Occurrence of stroke was ascertained by an independent Clinical Events Committee. Patients with anatomic or medical high-risk factors for carotid endarterectomy (CEA) were eligible to be enrolled in the ROADSTER trial.ResultsOverall, 165 patients were included in the long-term follow-up (112 of 141 patients from the pivotal phase and 53 of 78 patients from the extended access). Mean age was 73.9 years (range, 42.1-91.3 years). Patients aged 75 years and older were 43.3% of the cohort. The majority of patients were white (92.7%) and male (75.2%). Most patients were asymptomatic (79.9%). Anatomic risk factors were distributed as follows: contralateral carotid artery occlusion (11.0%), tandem stenosis of >70% (1.8%), high cervical carotid artery stenosis (25.0%), restenosis after CEA (25.6%), bilateral stenosis requiring treatment (4.3%), and hostile neck (14.6%). Medical high-risk criteria included two-vessel coronary artery disease (14.0%) and severe left ventricular dysfunction with ejection fraction <30% (1.8%). In general, 43.3% of patients had at least one anatomic high-risk factor, whereas 29.9% of patients had medical high-risk factors. Both subsets of factors were present simultaneously in 26.8% of the cohort. At 1-year follow-up, ipsilateral stroke incidence rate was 0.6%, and seven patients (4.2%) died. None of the deaths were neurologic in origin.ConclusionsTCAR with dynamic flow reversal had previously shown favorable 30-day perioperative outcomes. This excellent performance seems to extend to 1 year after TCAR as illustrated in this analysis. The promising results from the ROADSTER trial likely stem from the novel cerebral protection provided through the ENROUTE transcarotid NPS in comparison to distal embolic protection devices as well as the transcarotid approach's circumventing diseased aortic arch manipulation and minimizing embolization. TCAR offers a safe and durable revascularization option for patients who are deemed to be at high risk for CEA. 相似文献
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Juliette A.L. Santing Crispijn L. Van den Brand Korné Jellema 《The Journal of emergency medicine》2021,60(3):285-291
BackgroundEmergency departments (EDs) are faced with a growing number of patients with traumatic brain injury (TBI) using direct oral anticoagulants (DOACs). However, there remains uncertainty about the bleeding risk, rate of hematoma expansion, and the efficacy of reversal strategies in these patients.ObjectiveThis study aims to identify the risk of traumatic hemorrhagic complications in patients with TBI using DOACs.MethodsIn this retrospective study we included patients with TBI. All TBI patients were using DOACs, attended one of the three EDs of our hospital between January 2016 and October 2019, and received a computed tomography (CT) scan of the brain. The primary outcome was any traumatic intracranial hemorrhage on CT. Secondary outcomes were the use of reversal agents, secondary neurological deterioration, a neurosurgical intervention within 30 days after the injury, length of stay (LOS), Glasgow Outcome Scale (GOS) at discharge, and mortality.ResultsOf the included patients (N = 316), 24 patients (7.6%, 95% confidence interval [CI] 4.2–9.8) presented with a traumatic intracranial hematoma (ICH). Seven patients (2.2%, 95% CI 0.6–3.8) received a reversal agent and 1 patient (0.3%, 95% CI ?0.3–0.9) underwent a neurosurgical intervention. Of the 24 patients with a traumatic ICH, progression of the lesion was seen in 6 patients (1.9%, 95% CI 0.4–3.4). The mean LOS was 6.5 days (95% CI 3.0–10.1) and the mean GOS at discharge was 4 (95% CI 3.6–4.6). Death occurred in 1 patient (0.3%, 95% CI ?0.3–0.9) suffering from an ICH.ConclusionBased on the present findings it can be postulated that TBI patients using DOACs have a low risk for ICH. Hematoma progression occurred, however, in a substantial number of patients. Considering the retrospective nature of the present study, future prospective trials are needed to confirm this finding. 相似文献
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间变性淋巴瘤激酶(ALK)抑制剂是目前治疗NSCLC伴ALK阳性的有效药物,然而,耐药性的产生严重限制了其临床应用。本文对ALK抑制剂耐药产生的主要机制如二次基因突变、基因扩增、旁路通路激活等进行了简要介绍,并对联合用药、开发新型PROTAC降解剂等逆转耐药策略进行了综述,以期为ALK抑制剂药物的未来发展提供参考。 相似文献
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《Pharmacological reports : PR》2019,71(6):1125-1132
BackgroundOur group has previously shown that short-term treatment (48 h) with esmolol reduces left ventricular hypertrophy (LVH) in spontaneously hypertensive rats (SHRs). However, we do not know the mechanism that explain this effect. The aim of this study was to assess the role that the subcellular organelle phenotype plays in early cardiac reverse after short-term treatment with esmolol.Methods14-Month-old male SHRs were randomly assigned to receive esmolol (300 μg/kg/min) (SHR-E) or vehicle (SHR). Age-matched male Wistar-Kyoto rats (WKY) served as controls. After 48 h of treatment, an ultrastructural analysis of heart tissue (left ventricle) was performed. We studied cardiomyocyte ultrastructural remodeling of subcellular organelles by electronic microcopy in all groups.ResultsSHR group showed significant morphometric and stereological changes in mitochondria and subcellular organelles (cytoplasm and nucleus, myofibril structure, mitochondria structure, Z-Disk, intercalated disk, T-system and cystern), and also changes in the extracellular matrix (collagen) with respect to WKY group. Esmolol significantly improved the morphology and stereology mitochondrial, reduced the organelle phenotype abnormalities but no produced changes in the extracellular matrix with respect to SHR group. Interesantly, parameters of mitochondria (regularity factor, ellipsoidal form factor and density of volume), and all parameters of subcellular organelles returned to the normality in SHR-E.ConclusionOur results show that left ventricular hypertrophy reversal after short-term treatment with esmolol is associated with reversal of subcellular organelle phenotype. 相似文献
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《中国现代医生》2019,57(11):71-74
目的 研究胎臀位外倒转术(ECV)实施孕周情况,分析胎臀位外倒转术成功率的影响因素。 方法 临床纳入2017年9月~2018年9月期间在我院分娩的65例单胎孕妇作为研究对象,所有孕妇均接受外倒转术。观察不同孕周孕妇实施胎臀位外倒转术的成功率,分析孕周对手术成功的影响。收集所有孕妇临床资料,观察外倒转术成功与不成功孕妇临床资料差异性,采用Logistic回归方程分析胎臀位外倒转术成功的影响因素。 结果 不同孕周孕妇胎臀位外倒转术的成功率对比无差异(P>0.05)。手术成功孕妇与手术失败孕妇在臀位类型、产次、胎盘位置、羊水量以及脐带绕颈方面均有差异(P<0.05)。通过Logistic回归方程计算分析发现,上述有差异资料均为胎臀位外倒转术成功的影响因素。 结论 超过32周的孕妇不同孕周对ECV的成功率并无影响,影响ECV成功的因素包括臀位类型、产次、胎盘位置、羊水量以及脐带绕颈情况,严格掌握ECV的指征和操作方法,可有效提高ECV的成功率,保障孕妇安全。 相似文献
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《中国现代医生》2019,57(18):9-14+169
目的通过细胞和在体研究探讨ABT-737联合吉非替尼对EGFR T790M突变肺腺癌细胞EGFR-TKIs耐药的逆转机制。方法利用MTT和FCM法检测ABT-737联合吉非替尼对RPC-9细胞的增殖和凋亡的影响,以RT-PCR检测细胞内Bim、Bak、Caspase-3 mRNA表达水平。以皮下异位移植法建立EGFR T790M突变肺腺癌裸鼠模型,对各组瘤体组织进行组织病理学检查、基因测序法检测、Real-time PCR和免疫组织化学法分析Bim、Bak、Caspase-3 mRNA及蛋白表达水平。结果 ABT-737联合吉非替尼对RPC-9细胞有生长抑制作用和凋亡作用,且在ABT-737浓度4μmol/L范围内呈浓度依赖性,最大抑制率为(54.113±2.986)%,最大凋亡率为(55.042±3.151)%,差异均有统计学意义(P0.05);Bim、Bak及Caspase-3 mRNA表达水平随着ABT-737浓度的升高而增加(P0.05)。各组瘤体组织病理均为腺癌;ABT-737联合吉非替尼灌胃组裸鼠瘤体体积较其他组小(P0.05),Bim、Bak、Caspase-3 mRNA和蛋白表达水平较其他组显著增高(P0.05)。结论 ABT-737能增强吉非替尼促细胞凋亡作用,使耐药细胞重新发生凋亡。 相似文献