Association between preadmission low‐density lipoprotein cholesterol concentration and risk of large intracerebral hemorrhage: Results from the Kailuan study

BackgroundTo examine the association between low‐density lipoprotein cholesterol (LDL‐C) concentrations and the risk of a large hematoma volume after intracerebral hemorrhage (ICH).MethodsPatients from the Kailuan study (Tangshan, China) who were hospitalized with ICH during 2006 and 2020 were included in this study. The concentration of lipid concentrations, hematoma volume and other clinical characteristics were retrospectively collected and analyzed. Hematoma volumes were measured on the first available brain scan using the ABC/2 method. LDL‐C concentrations were obtained from the last physical examination before the occurrence of ICH. LDL‐C concentration was categorized into four groups in accordance with the quartiles. Logistic regression was used to assess the association between LDL‐C concentrations and the risk of a large hematoma volume of ≥30 ml. A generalized linear regression model was used to analyze the dose–response relationship between LDL‐C concentration and hematoma volume.ResultsA total of 836 patients with ICH were evaluated. In the Multivariate logistic regression, compared to the second quartile of LDL_C, the first quartile of LDL_C had a significantly higher risk of a large hematoma volume (OR 2.49 [95% CI 1.54–4.01]), and the higher quartile of LDL_C is not associated with higher odds of large hematoma volume. In the generalized linear regression model, the adjusted β for the association between LDL‐C concentration and hematoma volume was 9.46 (95% confidence interval 2.87–16.04), whereas higher LDL‐C concentration was not associated with a large hematoma volume.ConclusionsThis study confirmed that low LDL‐C concentrations prior to ICH are associated with a higher risk of a large hematoma volume.     

Non-Malignant Central Airway Obstruction

The most common causes of non-malignant central airway obstruction are post-intubation and post-tracheostomytracheal stenosis, followed by the presence of foreign bodies, benign endobronchial tumors and tracheobronchomalacia. Other causes, such as infectious processes or systemic diseases, are less frequent. Despite the existence of numerous classification systems, a consensus has not been reached on the use of any one of them in particular. A better understanding of the pathophysiology of this entity has allowed us to improve diagnosis and treatment. For the correct diagnosis of nonspecific clinical symptoms, pulmonary function tests, radiological studies and, more importantly, bronchoscopy must be performed. Treatment must be multidisciplinary and tailored to each patient, and will require surgery or endoscopic intervention using thermoablative and mechanical techniques.     

Resolution of Obstructive Atelectasis With Non-Invasive Mechanical Ventilation

Bronchoscopy is a commonly used technique in patients with atelectasis due to mucus plugs. We present here the case of an 82-year-old patient with a history of Meige's syndrome that developed acute respiratory failure due to atelectasis of the right upper lobe associated with hospital-acquired pneumonia. The patient had a severely reduced level of consciousness, significant work-of-breathing and severe hypercapnic acidosis, all of which contraindicated bronchoscopy. Bi-level non-invasive mechanical ventilation (NIMV) was initiated by way of a face mask. Progress was favorable, with clear clinical and gasometric improvement. The chest X-ray performed 12 h later showed complete resolution of the atelectasis. These data suggest that NIMV may be useful in the treatment of atelectasis is some critical patients.     

经自然腔道取标本完全腹腔镜下结直肠癌根治术的临床效果分析（附50例报道）*

目的探讨免腹部辅助切口、经自然腔道取标本法(NOSES)完全腹腔镜下结直肠癌根治术的操作要点、可行性、安全性和近期疗效。方法回顾性分析2016年1月-2017年6月该科50例行NOSES法完全腹腔镜下结直肠癌根治术患者的临床资料。结果 50例患者均顺利施行NOSES法完全腹腔镜下结直肠癌根治术。术中出血量(70.0±23.4)ml,手术时间(140.0±29.0)min,术中清扫淋巴结(14.0±2.3)枚,术后无盆腹腔感染及至随访截止日无肿瘤复发,术后下床时间(2.0±0.5)d,术后肛门排气时间(2.0±0.5)d,术后住院时间(8.5±3.0)d,术后发生吻合口漏1例,术后发生肺部感染0例,术后切缘癌细胞残留率0。所有患者随访3~24个月未见肿瘤局部复发及转移。结论免腹部切口NOSES法完全腹腔镜下结直肠癌根治术在临床上是安全可行,同时具有微创、快速康复、美容效果好和术后并发症少等优点。     

STEMI患者PCI术后单导联ST段回落不良的临床观察

目的探讨sT段抬高型急性心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）治疗后sT段回落（STR）不良的相关因素、对预后的影响,以及替罗非班对其预后的影响。方法收集116例行急诊PCI术的STEMI患者的临床资料,及心电图、冠脉造影、心超结果,记录院内不良心血管事件（MACE）,按术后sT段下降≥50％与〈50％,将患者分为STR良好组与STR不良组,统计分析其相关因素及短期预后,比较替罗非班应用对STR不良患者的MACE发生率的影响,筛选院内心血管不良事件发生的独立预测因素。结果STR不良与心功能分级、合并糖尿病、存在左主干病变、起病至球囊扩张时间呈显著正相关;STR不良组MACE发生率显著高于STR组,左室射血分数则显著低于STR组;应用替罗非班可显著降低MACE发生率;且STR不良是MACE的独立预测因素之一。结论心肌梗死患者sT段回落不良反应了心肌组织水平灌注不良,这些患者发生MACE的风险明显升高,而替罗非班能有效干预。     

无张力疝修补术在老年人复发腹股沟斜疝中的应用

目的：探讨无张力疝修补术治疗老年人复发斜疝的方法。方法：回顾性分析无张力疝修补术治疗22例老年人复发腹股沟斜疝的临床资料。结果：手术时间35—65min,随访3月～2年,1例术后8个月复发。结论：无张力疝修补术是一种操作简单、创伤小、疗效满意及复发率低的疝修补术,宜作为治疗老年人复发斜疝的首选方法之一。     

T-cell subsets in multiple sclerosis: Lack of correlation between helper and suppressor T cells and the clinical state

Peripheral blood T-lymphocyte subsets were investigated in a group of 26 multiple sclerosis (MS) patients of different clinical categories and compared to those of 15 normal controls and 7 other patients with known immunoregulatory disorders. In addition 17 well-documented acute relapses in 11 MS patients were also studied, some of whom were tested serially prior to, during, and after the acute attack. Using three different commercial preparations of monoclonal antibodies directed against human T3, T4, and T8 lymphocyte markers, none of the MS patients irrespective of disease category exhibited any changes in the absolute numbers of T-cell subsets or ratios thereof; this was true during either quiescent or active stages of the disease. In contrast, several patients with known immunoregulatory disorders exhibited clear changes in T4/T8 ratios. Factors such as type of patient studied, sampling error, and methods of isolation of mononuclear cells, as well as source of monoclonal antibody, failed to explain the lack of change in T-cell subsets in these patients. Thus, our data fail to confirm the previous reports of a decrease in the absolute numbers of T8 cells or the increase in the T4/T8 ratios in active or quiescent MS patients. These negative findings underscore the need for further studies relating these markers to meaningful functional properties of these cells and their interaction with the relevant target organs.     

Effect of Immunosuppressive Therapy and Biopsy Status in Monitoring Therapy Response in Suspected Cardiac Sarcoidosis

BackgroundPatients with suspected cardiac sarcoidosis frequently undergo fluorodeoxyglucose (FDG)–positron emission tomography (PET)/computed tomography (CT) imaging to assess disease activity at baseline and after treatment initiation.ObjectivesThis study investigated the effect of immunosuppressive therapy and biopsy status to achieve complete treatment response (CTR), partial treatment response (PTR), or no response (NR) on myocardial FDG-PET/CT.MethodsThis study analyzed 83 patients with suspected cardiac sarcoidosis (aged 53 ± 1.8 years, 71% were male, 69% were White, 61% had a history of biopsy-confirmed sarcoidosis) who were treatment naive, had evidence of myocardial FDG at baseline, and underwent repeat PET imaging after treatment initiation. CTR was graded visually, and PTR/NR were measured both visually and quantitatively using the total glycolytic activity. Patients were also evaluated for the occurrence of death, sustained ventricular arrhythmias, and heart failure admissions.ResultsOverall, 59 patients (71%) achieved CTR/PTR (30%/41%) at follow-up scan (P = 0.04). Total glycolytic activity and visual estimate of PTR/NR had excellent agreement (κ = 0.86 [95% CI: 0.72-0.99]; P < 0.0001). In patients receiving prednisone only, the highest rates of CTR/PTR were observed in patients initiated on moderate or high dose (P < 0.01). In a regression model, moderate prednisone start dose (P = 0.03) was more strongly associated with achieving CTR/PTR than was high prednisone start dose. However, the latter patients were tapered faster between start dose and follow-up scan (P < 0.01). After a median follow-up of 4.7 (IQR: 3.1-7.8) years, patients who were biopsy-proven (vs non-biopsy-proven; P = 0.029) and with preserved left ventricular function (P = 002) were less likely to experience major adverse cardiac events. Outcomes based on treatment response status (CTR vs PTR vs NR; P = 0.23) were not significantly different.ConclusionsAmong patients with suspected sarcoidosis and evidence of myocardial inflammation, treatment response by serial FDG-PET was variable, but a favorable response was more common when using moderate-to-high intensity prednisone dose. Biopsy-proven individuals and those with preserved systolic function were less likely to experience adverse outcomes during follow-up.     

Microcirculatory derangements in acute pancreatitis

During the past decade, a considerable number of experimental studies have confirmed the hypothesis that microcirculatory derangements play a pivotal role in the pathogenesis of acute pancreatitis, including the process of conversion from edematous to necrotizing injury. Predominant microcirculatory disorders are nutritive capillary perfusion failure, with the consequence of prolonged focal hypoxia or anoxia, and inflammation-associated microvascular leukocyte recruitment, CD11b- and intercellular adhesion molecule (ICAM)-1-mediated leukocyte-endothelial cell interaction and loss of endothelial integrity, which may result in both edema formation and necrosis. A variety of proinflammatory mediators, such as oxygen radicals, leukotrienes, platelet-activating factor, and interleukins, but also bradykinin and endothelins, seem to be involved in triggering the manifestations of these microcirculatory disorders. In contrast, the anti-inflammatory interleukin-10, as well as nitric oxide, are thought to be capable of protecting from these pancreatitis-associated microvascular injuries. This knowledge may be encouraging for the development of novel therapeutic strategies, aiming at the attenuation of microcirculatory disorders, and, thus, preventing tissue injury in acute pancreatitis.     

Intracoronary verapamil for reversal of no-reflow during coronary angioplasty for acute myocardial infarction.

No-reflow is a frequent observation during direct PTCA for acute myocardial infarction (AMI) and associated with a poor clinical outcome. This study assesses the value of verapamil for reversal of no-reflow during PTCA for AMI. In a consecutive series of 212 direct or rescue PTCAs for AMI, a TIMI flow grade < 3 was observed in 23 patients (10.8%). Ten of these patients had received GP IIb/IIIa antagonists before PTCA. Seven patients with AMI and TIMI grade 3 flow served as controls. All lesions were treated by stents. In 18 patients with systolic blood pressure > 90 mm Hg, nitroglycerine (0.1 mg i.c.) was given. Verapamil (1 mg over 2 min) was given via an infusion catheter distal to the angioplasty site. Before and after nitroglycerine, after verapamil, and 15 min later coronary flow was assessed by the TIMI frame count method (TFC). Nitroglycerine had no effect on TFC. Verapamil reduced TFC from 56 +/- 9 frames to 24 +/- 4 (P < 0.001). In controls, TFC did not change significantly. The TIMI flow grade was restored to TIMI flow grade 3 in 65%. In two of seven right coronary and one of three circumflex arteries, intermittent AV block II occurred during verapamil injection, which disappeared after atropine. No-reflow after PTCA for AMI can be reversed by intracoronary verapamil. This supports the hypothesis that no-reflow is caused by acute microvascular dysfunction probably because of a disorder in calcium homeostasis or microvascular spasm.