Recanalization Treatment for Acute Stroke: Can We Skip the Bridge?

More than 2 million new ischemic stroke patients are diagnosed every year in China, with a prevalence of about 11 million.Stroke is the leading cause of death i...     

年龄对阵发性心房颤动终止后长间歇患者窦房结功能的影响

目的：探讨年龄对阵发性心房颤动（房颤）终止后出现长间歇的患者窦房结功能的影响。方法连续入选2011年5月至2013年5月于我院就诊的358例接受射频消融术的阵发性房颤患者,年龄（63±11）岁,男220例,女138例。根据年龄将其分为两组：即非老年组（年龄＜65岁,n＝177）及老年组（年龄≥65岁,n＝181）。比较两组患者术前长间歇的检出率及术后窦房结功能的恢复率。结果老年阵发性房颤患者术前更易出现提示窦房结功能障碍的房颤终止后长间歇,其检出率显著高于非老年组（14.4% vs 5.6%,P＜0.01）。术后随访（15.0±8.7）个月,非老年组的窦房结功能障碍检出率显著低于术前（1.1%vs 5.6%,P＜0.05）,而老年组仅有降低趋势（9.4%vs 14.4%, P＞0.05）。老年患者术后窦房结功能的好转率显著低于非老年患者（34.6%vs 80.0%,P＜0.05）。结论年龄对阵发性房颤终止后出现长间歇患者的窦房结功能评价具有重要价值。老年房颤患者经射频消融术治疗后,多数窦房结功能无明显改善,常须植入永久起搏器治疗。     

加减驻景方联合雷珠单抗治疗高度近视性黄斑出血

目的：观察加减驻景方治疗高度近视黄斑出血的临床疗效。

方法：将患者42例42眼根据治疗方法不同分为加减驻景方组25例25眼,用加减驻景方治疗; 加减驻景方联合雷珠单抗组(联合组)17例17眼,采用玻璃体腔内注射雷珠单抗同时给予加减驻景方进行治疗,治疗前后采用OCT检测中心视网膜厚度,随访3mo,观察两组的疗效。

结果：联合组在治疗3mo后总有效率达到82%,加减驻景方组总有效率达到60%; 联合组在治疗3mo后眼底出血吸收总有效率达88%,加减驻景方组的有效率达64%; 在降低中心视网膜厚度方面,各组治疗后与治疗前比较及两组组间比较,差异均有统计学意义(P<0.05)。

结论：中药加减驻景方能有效地延缓病情的发展、减少病变的反复次数及提高患者的视力。     

Biomechanical Comparison of Two Kinds of Internal Fixation in a Type C Zone II Pelvic Fracture Model

Background:

Unstable pelvic fractures are complex and serious injuries. Selection of a fixation method for these fractures remains a challenging problem for orthopedic surgeons. This study aimed to compare the stability of Tile C pelvic fractures fixed with two iliosacral (IS) screws and minimally invasive adjustable plate (MIAP) combined with one IS screw.

Methods:

This study was a biomechanical experiment. Six embalmed specimens of the adult pelvis were used. The soft tissue was removed from the specimens, and the spines from the fourth lumbar vertebra to the proximal one-third of both femurs were retained. The pubic symphysis, bilateral sacroiliac joints and ligaments, bilateral hip joints, bilateral sacrotuberous ligaments, and bilateral sacrospinous ligaments were intact. Tile C pelvic fractures were made on the specimens. The symphysis pubis was fixed with a plate, and the fracture on the posterior pelvic ring was fixed with two kinds of internal fixation in turn. The specimens were placed in a biomechanical machine at a standing neutral posture. A cyclic vertical load of up to 500 N was applied, and displacement was recorded. Shifts in the fracture gap were measured by a grating displacement sensor. Statistical analysis used: Paired-samples t-test.

Results:

Under the vertical load of 100, 200, 300, 400, and 500 N, the average displacement of the specimens fixed with MIAP combined with one IS screw was 0.46, 0.735, 1.377, 1.823, and 2.215 mm, respectively, which was significantly lower than that of specimens fixed with two IS screws under corresponding load (P < 0.05). Under the vertical load of 500 N, the shift in the fracture gap of specimens fixed with MIAP combined with one IS screw was 0.261 ± 0.095 mm, and that of specimens fixed with two IS screws was 0.809 ± 0.170 mm. The difference was significant (P < 0.05).

Conclusion:

The stability of Tile C pelvic fractures fixed with MIAP combined with one IS screw was better than that fixed with two IS screws.     

Edaravone alleviates Alzheimer’s disease-type pathologies and cognitive deficits

Alzheimer’s disease (AD) is one of most devastating diseases affecting elderly people. Amyloid-β (Aβ) accumulation and the downstream pathological events such as oxidative stress play critical roles in pathogenesis of AD. Lessons from failures of current clinical trials suggest that targeting multiple key pathways of the AD pathogenesis is necessary to halt the disease progression. Here we show that Edaravone, a free radical scavenger that is marketed for acute ischemic stroke, has a potent capacity of inhibiting Aβ aggregation and attenuating Aβ-induced oxidation in vitro. When given before or after the onset of Aβ deposition via i.p. injection, Edaravone substantially reduces Aβ deposition, alleviates oxidative stress, attenuates the downstream pathologies including Tau hyperphosphorylation, glial activation, neuroinflammation, neuronal loss, synaptic dysfunction, and rescues the behavioral deficits of APPswe/PS1 mice. Oral administration of Edaravone also ameliorates the AD-like pathologies and memory deficits of the mice. These findings suggest that Edaravone holds a promise as a therapeutic agent for AD by targeting multiple key pathways of the disease pathogenesis.Alzheimer’s disease (AD) is the most common form of dementia among the elderly, and the incidence increases with the aging population worldwide, causing a huge social and economic burden for families and societies (1, 2). Accumulating evidence indicates that amyloid-β (Aβ) and its oligomers play central roles in the pathogenesis of AD (3). Despite significant progress that has been made toward understanding the pathogenesis of AD in recent years, no efficient disease-modifying therapeutics are available for the management of AD (4). In recent years, a number of drug candidates targeting Aβ through immunotherapy or using secretase inhibitors have proceeded to clinical trials but all failed to improve cognitive functions in patients (5). Clearly, lessons have been learned through failed clinical trials, indicating that a drug targeting a single target or pathway does not work on this complex disease (6). Aβ, overproduced and accumulated in AD brains, triggers subsequent pathological events such as synaptic degeneration, Tau-hyperphosphorylation, oxidative stress, neuroinflammation, neurite degeneration, and neuronal loss (7, 8). These secondary pathological events can form vicious cycles themselves and accelerate the disease progression (9–11). Therefore, we proposed that it is critical to discover novel drugs, which target multiple key pathways in the pathogenesis of AD, to improve or halt the progression of the disease (6).As a series of new drugs for AD failed in clinical trials, it is necessary to choose drugs with both an established safety profile and a mechanism-based rationale for future clinical trials. One approach is to screen current drugs approved by regulatory bodies for other indications and reposition them for AD (12). In the present study, we took such an approach and investigated the potential therapeutic effect of Edaravone, an oxygen radical scavenger that is currently used for the treatment of acute ischemic stroke (13, 14). Oxidative imbalance is a manifestation of AD even preceding Aβ deposition and neurofibrillary tangle (NFT) (15). Aβ is a highly redox active peptide that generates reactive oxygen species (ROS) (16, 17). ROS is one of the key factors, which promote several Aβ-driven vicious cycles and propagate the pathogenesis of AD (9–11). Previous study found that Edaravone was able to attenuate Aβ-induced oxidative stress and neurotoxicity (18, 19). Aβ accumulation and aggregation into amyloid plaques in the brain are considered to trigger the AD pathogenesis. In the present study, we found that Edaravone can interact with Aβ and is competent in inhibiting Aβ aggregation and disaggregating preformed Aβ fibrils, suggesting that Edaravone is a scavenger for both ROS and Aβ. In animal models, we found that Edaravone, given before or after the onset of Aβ deposition, reduced Aβ burden in the brain and cerebral arterioles by inhibiting Aβ deposition and reducing BACE1 processing of the amyloid-β precursor protein (APP), attenuated oxidative stress and neuroinflammation, inhibited Tau hyperphosphorylation, protected brain neurons from loss and synaptic degeneration, and finally rescued the cognitive deficits of aged APPswe/PS1dE9 (APP/PS1) mice.     

血管危险因素对老年性痴呆认知功能障碍进展的影响

目的：通过前瞻性研究探讨血管危险因素对阿尔茨海默病（AD）认知功能障碍进展的影响。方法：AD患者311例，分为2组（有或无血管危险因素组），随访3年，采用询问病史、实验室检查、成套神经心理检测等收集人文情况、血管危险因素及认知功能变化等资料，完成随访243例。运用t检验、X^2检验和多元线性逐步回归模型分析血管危险因素与AD认知功能障碍进展的关系。结果：单因素分析表明，同无血管危险因素者相比，AD患者中有血管危险因素者随访3年后认知功能障碍的进展更快（P〈0．01）。多因素分析表明，短暂性脑缺血发作、糖尿病、高血压、颈动脉粥样硬化斑块、当前吸烟和每日饮酒是AD认知功能障碍进展的独立危险因素。结论：血管危险因素加剧了AD认知功能障碍的进展，提示血管危险因素参与了AD发病的过程，积极防治血管危险因素可能在一定程度上减缓AD的进展。     

贝母中浙贝甲素和浙贝乙素的柱前衍生化高效液相色谱测定

本文提出了一个用于贝母生物碱浙贝甲素和浙贝乙素测定的柱前衍生化反相高效液相色谱法。浙贝甲素和浙贝乙素苯甲酸酯的峰面积Ｙ１，Ｙ２与该二生物碱的重量Ｘ１，Ｘ２分别在０．５０４～３．１２６μｇ和０．５２０～３．２８μｇ范围内呈良好的线性关系。回归方程为Ｙ１＝－３．８３×１０３＋１．３３×１０５Ｘ１，ｒ＝０９９８，Ｙ２＝－７．８６×１０２＋６．３３×１０４Ｘ２，ｒ＝０．９９５；平均回收率分别为９８．０％（ｎ＝５，ＲＳＤ＝２．１％）和１０１．０％（ｎ＝５，ＲＳＤ＝４．１％）。本研究测定了１５种不同产地、不同种的中药贝母中浙贝甲素和渐贝乙素的含量。结果表明，浙贝甲素和浙贝乙素是贝母属植物鳞茎中的主要化学成分。     

Radiofrequency Catheter Ablation Versus Cryoballoon Ablation in the Treatment of Paroxysmal Atrial Fibrillation: A Cost-effectiveness Analysis in China

Purpose

The aim of this study was to evaluate the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared with cryoballoon (CB) ablation in the treatment of patients with paroxysmal atrial fibrillation (PAF) from the payer's perspective in China.