一种适用于颅内外血管重建研究的大鼠慢性脑缺血模型

目的：检测结扎大鼠双侧颈内动脉及一侧椎动脉（3-VO）是否可以在保留颈外动脉的同时,造成大鼠慢性脑缺血。方法分别制造假手术对照组、双侧颈总动脉结扎组（2-VO）及3-VO组动物模型;于造模4周后行脑血流量测定;于第8周行Morris水迷宫实验测定大鼠的学习记忆能力;行为学实验结束后处死大鼠,观察大鼠海马CA1区细胞的形态学变化。结果脑血流测定结果显示与假手术[（47±8．797）ml·min^－1·100 g^－1]相比,2-VO[（24．30±8．999）ml·min^－1·100 g^－1]、3-VO[（9．870±2．208）ml·min^－1·100 g^－1]组脑血流量值均降低,差异有统计学意义（P＜0．01）。 Morris水迷宫实验显示,2-VO组[（14．78±7．84） s]、3-VO[（14．86±7．96）s]组第5天潜伏期与假手术组[（8．33±4．88）s]相比,时间较长,差异有统计学意义（P＜0．01）,但2-VO组与3-VO组相比,其潜伏期无明显差异;与假手术组[（37．20±9．21）s,（10．01±2．91）次]相比,2-VO组[（20．13±5．80）s,（6．60±3．19）次]、3-VO组[（20．05±5．76）s,（6．55±2．59）次]目标象限停留时间及穿越平台次数均显著减少,差异有统计学意义（P＜0．01）。2-VO、3-VO模型组海马CA1区有明显病理形态学改变。结论结扎双侧颈内动脉及一侧椎动脉可造成大鼠慢性脑缺血,并造成与2-VO相似的行为学表现。     

对老年冠心病血运重建术后基于物联网平台的医院综合管理模式的药物经济学分析

目的：探讨基于物联网平台的医院综合管理模式对患者治疗费用的影响。方法：以在某院门诊及病区就诊的老年冠心病血运重建术后患者200例为研究对象,随机分为对照组与观察组各100例。对照组给予常规诊疗及门诊随访管理,观察组给予基于物联网的综合管理模式进行诊治及随访。2组患者均随访12个月,研究前、随访6个月及12个月时采用欧洲五维健康量表评价患者生存质量,计算患者质量调整生命年（QALYs）并作为效用指标;以研究期间患者产生的费用作为成本指标,采用成本-效用分析方法进行药物经济学分析。结果：与对照组相比,观察组在直接成本、间接成本及总成本均明显降低,差异具有显著性（P < 0.05）;直接成本中,观察组在直接医疗成本及直接非医疗成本均明显低于对照组,差异具有显著性（P < 0.05）;2组效用值及VAS评分随时间延长呈增加趋势,与随访前相比,随访6个月及12个月时,2组效用值均显著增加且效应值的差异具有显著性（P < 0.05）;每增加一个质量调整生命年,对照组多花费4 875.53元。结论：基于物联网平台的医院综合管理模是一种经济、有效的老年冠心病血运重建术后管理模式,改善患者生活质量的同时也可节省治疗成本,值得临床参考借鉴。     

Endovascular iliac rescue technique for complete arterial avulsion after transcatheter aortic valve replacement

Transcatheter aortic valve replacement (TAVR) has emerged as an alternative therapy to open aortic valve repair for high‐risk patients with aortic stenosis, but larger delivery sheath size is associated with vascular complications. We report 2 cases in which a minimally invasive technique was used for the hybrid repair of confirmed or suspected large‐bore sheath traumatic avulsion (i.e., “iliac on a stick”) after TAVR. We believe our hybrid approach to rescuing the iliac artery in suspected or confirmed complete artery avulsion could improve outcomes for patients who require TAVR. © 2013 Wiley Periodicals, Inc.     

Thrombus aspiration during primary percutaneous coronary intervention improved outcome in patients with STEMI and a large thrombus burden

BackgroundThe benefit of thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) to patients with ST-segment elevation myocardial infarction (STEMI) remains controversial. This study aimed to assess TA''s impact on the outcome and prognosis for patients with STEMI and a large thrombus burden during PPCI.MethodsThis retrospective study evaluated consecutive patients with STEMI and a large thrombus burden (thrombolysis in myocardial infraction [TIMI] thrombus grade ≥4) who underwent conventional PPCI (n = 126) or PPCI + TA (n = 208) between February 2017 and January 2019. The procedure outcome and clinical prognosis were compared.ResultsPostprocedural vessel diameter was larger, and corrected TIMI frame count (cTFC) was lower in the PPCI + TA compared with the PPCI group. The proportion of postprocedural TIMI 3 flow was 83.3% in the PPC group and 94.2% in the PPCI+TA group. During the 12-month follow-up, no significant differences existed in the incidence of cardiac death, reinfarction, stent thrombosis, target vessel revascularization, or stroke.ConclusionApplication of TA in patients with STEMI and a large thrombus burden during PPCI may improve the procedural outcome, but it showed no benefit on the clinical prognosis in the 12-month follow-up. Longer follow-up studies are needed to confirm TA''s clinical implications in patients with STEMI.     

Pilates method on pulmonary function and range of motion after coronary artery bypass grafting: A clinical trial

IntroductionCoronary artery bypass grafting (CABG) can compromise pulmonary function and range of motion (ROM) of the shoulder and knee joints due to median sternotomy and saphenectomy, the Pilates method being a strategy for reducing loss.ObjectiveTo evaluate the effect of applying the Pilates method on pulmonary function and ROM in patients undergoing CABG.Methodology: This is a clinical trial. Patients were evaluated preoperatively at discharge from the hospital for shoulder flexion and abduction and knee flexion-extension. In addition, vital capacity(VC), maximum inspiratory pressure(MIP), expiratory pressure(MEP) and peak expiratory flow(PEF) were evaluated. Upon discharge from the Intensive Care Unit (ICU), they were divided into a control group(CG) that received conventional assistance and Pilates(PG) was increased with Pilates method techniques.Results40 patients were analyzed, 25 were men(61%), with a mean age of 66 ± 7 years. At the end, the left shoulder abduction in the CG was 105±9vs115 ± 8 in the PG(p = 0.03), the right shoulder abduction in the CG 104 ± 11vs116 ± 10 in the PG(p < 0.001) and right knee flexion in the CG 78 ± 13vs92 ± 9 in the PG(0.002). In relation to MIP, the CG had a loss of 32 ± 8 while the PG 18 ± 10cmH2O(p < 0.001), the worsening MEP was 31 ± 9(CG)vs29 ± 11cmH2O(PG)(p = 0.53), the VC in the CG reduced 8±9vs6±8 in the PG(p = 0.23) and the PEF reduced 107 ± 5 in the GCvs83 ± 88 in the PG(p = 0.09).ConclusionIt is concluded that the Pilates method decreased the loss of ROM and maximum inspiratory pressure in patients undergoing coronary artery bypass grafting.     

CT灌注成像对烟雾病行脑血管重建术的疗效评价

目的 探讨CT灌注成像技术(CTP)在出血型烟雾病中的应用价值和评价颞浅-大脑中动脉搭桥术(STA-MCA)手术疗效.方法 20例出血型烟雾病患者在实施STA-MCA手术前、术后1周和术后3个月分别行CTP检查.对患者手术前腩血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)进行定量和定性分析,并对手术前后及随访的CBF、CBV、MTT进行对比分析.结果 10例患者术前手术侧与对侧比较,额、颞叶CBF降低,CBV增加,MTT延长;术后1周复查,术侧额、颞叶与术前比较发现,rMTT降低,rCBV不变,rCBF增加;术后3个月复查,与术后1周比较,额、颞叶rMTT、rCBV降低;差异有统计学意义(P<0.05).结论 CTP能检测脑缺血的部位,有助于出血型烟雾病术前治疗方法的选择和术后疗效观察;出血型烟雾病仍存在脑灌注严重不足,以额、颞叶明显,STA-MCA搭桥术能增加额、颞叶脑血供,预防缺血或出血性卒中发生.     

Controlled blunt microdissection for percutaneous recanalization of lower limb arterial chronic total occlusions: a single center experience.

BACKGROUND: Percutaneous techniques for the revascularization of symptomatic lower limb arterial chronic total occlusions (CTOs) remain suboptimal due to difficulty in safely and reliably crossing these heavily calcified lesions using standard guidewire and balloon technology. OBJECTIVES: The objective of this prospective study was to evaluate the technical success and safety of controlled blunt microdissection (CMD) for the treatment of resistant peripheral CTOs. METHODS: This series enrolled 36 patients (26 men; mean age 67 +/- 12 years), with 44 symptomatic CTOs (2 terminal aortic, 24 iliac, 16 femoral, and 2 popliteal), which had previously failed conventional percutaneous revascularization. CMD was carried out using a specialized prototype catheter. Actuation of the hinged jaws of this CMD catheter created a channel within the occluded arterial segment for guidewire passage, and subsequent angioplasty and stenting using standard procedures. The problem of subintimal CMD catheter passage, creating an eccentric channel, was addressed using a second novel device, the true-lumen reentry (LRE) catheter, which allowed reentry into the downstream lumen. RESULTS: Procedural success, evaluated angiographically, was achieved in 40 (91%) of the 44 CTOs. Fourteen (35%) of these 40 successful recanalizations required guidewire redirection, using the LRE catheter for lesion traversal. There were no complications related to CMD per se; although one patient experienced acute in-stent thrombosis, managed successfully with intra-arterial thrombolysis. CONCLUSIONS: We therefore conclude that CMD can be used safely and successfully to facilitate recanalization of resistant CTOs in the pelvic and lower limb arteries.