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1.
PurposeThe purpose of this study was to make a systematic review and meta-analysis to determine the stent diameter (8 mm vs. 10 mm) that conveys better safety and clinical efficacy for transjugular intrahepatic portosystemic shunt (TIPS).Materials and methodsFour databases were used to identify clinical trials published from inception until March 2020. Data were extracted to estimate and compare one-year and three-year overall survivals, hepatic encephalopathy, variceal rebleeding, and shunt dysfunction rates between patients with 8 mm covered stents and those with 10 mm covered stents.ResultsFive eligible studies were selected, which included 489 patients (316 men, 173 women). The 8 mm covered stent group had higher efficacy regarding one-year or three-year overall survival (odds ratio [OR], 2.88; P = 0.003) and (OR, 1.81; P = 0.04) and lower hepatic encephalopathy (OR, 0.69; P = 0.04) compared with 10 mm covered stent group. There were no significant differences in variceal rebleeding rate (OR 0.80; P = 0.67). However, shunt dysfunction was lower in 10 mm covered stent group (OR, 2.26; P = 0.003).ConclusionsOur results suggest that the use of 8 mm covered stents should be preferred to that of 10 mm covered stents for TIPS placement when portal pressure is frequently monitored.  相似文献   
2.
目的 运用核磁共振弥散张量成像技术(DTI),从皮质脊髓束损伤程度评价的角度,探讨肾虚髓亏证与急性缺血性脑卒中运动功能缺损程度相关性,丰富中风病病机及证候诊断,拓宽缺血性脑卒中的中医药防治思路,为急性缺血性脑卒中肾虚髓亏证患者运动功能损伤程度提供临床依据,强调肾虚髓亏证在急性缺血性脑卒中运动功能损伤中的重要意义。方法 纳入符合诊断标准的90例病例,根据证候分别归入肾虚髓亏组和非肾虚髓亏组,每组各45例。每组患者均给予常规西药治疗。对两组患者入院后行弥散张量成像检测,同时分别于治疗前及治疗后14天,记录两组患者NIHSS评分、改良Barthel指数量表及简化Fugl-Meyer运动功能评分量表评分,比较两组病例发病时的轻重程度及治疗前后两组病例组间的恢复差异。结果 研究显示,治疗前肾虚髓亏组在NIHSS评分方面高于非肾虚髓亏组(P<0.05);治疗前肾虚髓亏组在改良Barthel指数量表及简化Fugl-Meyer运动功能评分方面低于非肾虚髓亏组(P<0.05)。治疗前后NIHSS评分、改良Barthel指数评分及简化Fugl-Meyer运动功能评分改善情况,非肾虚髓亏组要优于肾虚髓亏组(P<0.05)。治疗前两组患者在健侧内囊后肢及大脑脚外侧处FA值及ADC值无明显差异;肾虚髓亏组在患侧内囊后肢及大脑脚外侧处FA值及ADC值均低于非肾虚髓亏组(P<0.05)。相关性分析得出,两组患者患侧内囊后肢FA值与患者治疗前NIHSS评分呈负相关;两组患者患侧内囊后肢FA值与患者改良Barthel指数评分及简化Fugl-Meyer运动功能评分呈正相关;肾虚髓亏组患者患侧内囊后肢FA值与肾虚髓亏证中医证候评分呈负相关。结论 肾虚髓亏是急性缺血性脑卒中运动功能障碍的重要病机。研究结果显示,两组皮质脊髓束损伤程度与神经功能及运动功能损伤存在相关性,且肾虚髓亏组在皮质脊髓束的损伤程度方面与其中医证候评分呈负相关。  相似文献   
3.
观察并评估角膜电刺激对糖尿病大鼠前部缺血性视神经病变(AION)模型的影响。方法:实验 研究。健康雄性Sparague-Dawley大鼠40只,随机分组后抽出8只作为正常大鼠组。余下32只先予 以链脲佐菌素腹腔注射建立糖尿病大鼠模型,将造模成功的大鼠随机抽出8只作为糖尿病组,余下 24只糖尿病大鼠采用孟加拉玫瑰红联合532 nm激光方法建立AION大鼠模型。将24只造模成功的 AION大鼠随机分成3组,每组8只,分别为AION模型组,不予任何处理;电刺激组,予以角膜电刺 激(刺激参数为:电流1 mA,频率20 Hz,波宽1 ms/phase,刺激时间1 h,隔日1次,刺激2周);假电 刺激组,电极安放位置与电刺激组相同,仅不接通电源。2周后5组大鼠进行眼底照相、光学相干断 层扫描和视觉诱发电位,然后处死,行视网膜及视神经冰冻切片,苏木精伊红染色观察。数据采用 单因素方差分析和LSD-t检验进行分析。结果:正常大鼠组视盘上半部视网膜厚度为(211±13)μm, 糖尿病大鼠组为(206±16)μm,AION模型组为(240±54)μm,假电刺激组为(216±11)μm,电刺 激组为(198±4)μm,5组视盘上半部视网膜厚度差异有统计学意义(F=2.854,P=0.038)。其中AION 模型组视盘上半部视网膜厚度高于正常组、糖尿病组、电刺激组,差异均有统计学意义(P<0.05); 正常组与糖尿病组差异无统计学意义,AION模型组与假电刺激组未见明显差异。视觉诱发电位示 AION模型组N1潜伏期较电刺激组延长,差异有统计学意义(t=4.1,P<0.001);AION模型组P1潜伏 期较正常组、糖尿病组、假电刺激组、电刺激组延长,差异均有统计学意义(t=4.1、2.5、2.6、3.2, P<0.05);电刺激组N1-P1波幅大于假电刺激组,差异有统计学意义(t=4.0,P<0.001)。结论:角膜电 刺激能促进糖尿病大鼠前部缺血性视神经病变模型肿胀的视盘变薄,加速视盘水肿的消退,同时在 一定程度上改善视功能。  相似文献   
4.
Introduction: Ischemic stroke is becoming a primary cause of disability and death worldwide. To date, therapeutic options remain limited focusing on mechanical thrombolysis or administration of thrombolytic agents. However, these therapies do not promote neuroprotection and neuro-restoration of the ischemic area of the brain.

Areas covered: This review highlights the option of minimal invasive, intra-arterial, administration of biological agents for stroke therapy. The authors provide an update of all available studies, discuss issues that influence outcomes and describe future perspectives which aim to improve clinical outcomes. New therapeutic options based on cellular and molecular interactions following an ischemic brain event, will be highlighted.

Expert opinion: Intra-arterial administration of biological agents during trans-catheter thrombolysis or thrombectomy could limit neuronal cell death and facilitate regeneration or neurogenesis following ischemic brain injury. Despite the initial progress, further meticulous studies are needed in order to establish the clinical use of stem cell-induced neuroprotection and neuroregeneration.  相似文献   

5.
AimsWe previously showed that the protective effects of endothelial progenitor cells (EPCs)‐released exosomes (EPC‐EXs) on endothelium in diabetes. However, whether EPC‐EXs are protective in diabetic ischemic stroke is unknown. Here, we investigated the effects of EPC‐EXs on diabetic stroke mice and tested whether miR‐126 enriched EPC‐EXs (EPC‐EXsmiR126) have enhanced efficacy.MethodsThe db/db mice subjected to ischemic stroke were intravenously administrated with EPC‐EXs 2 hours after ischemic stroke. The infarct volume, cerebral microvascular density (MVD), cerebral blood flow (CBF), neurological function, angiogenesis and neurogenesis, and levels of cleaved caspase‐3, miR‐126, and VEGFR2 were measured on day 2 and 14.ResultsWe found that (a) injected EPC‐EXs merged with brain endothelial cells, neurons, astrocytes, and microglia in the peri‐infarct area; (b) EPC‐EXsmiR126 were more effective than EPC‐EXs in decreasing infarct size and increasing CBF and MVD, and in promoting angiogenesis and neurogenesis as well as neurological functional recovery; (c) These effects were accompanied with downregulated cleaved caspase‐3 on day 2 and vascular endothelial growth factor receptor 2 (VEGFR2) upregulation till day 14.ConclusionOur results indicate that enrichment of miR126 enhanced the therapeutic efficacy of EPC‐EXs on diabetic ischemic stroke by attenuating acute injury and promoting neurological function recovery.  相似文献   
6.
观察电针对缺血性脑卒中大鼠记忆功能及脑内突触囊泡蛋白(synaptic vesicular protein,SYN)的影响,探讨其可能的作用机制。方法 选取90 只SD大鼠随机分为模型组、电针组、假手术组,每组各30只。线拴法制作急性大脑中动脉缺血大鼠模型。电针组取“百会”“水沟”“内关”“三阴交”穴位,应用“醒脑开窍”法进行电针,每天电针30 min,连续电针6 d休1 d,7 d为一个疗程,首次电针干预在造模成功24 h后进行。模型组和假手术组不进行电针干预。大鼠分别按7、14、21 d 3个亚组进行运动及记忆功能评分,TTC染色测定脑梗死体积、Western blot检测脑内SYN的蛋白表达。结果 电针组运动功能评分较模型组显著降低(P<0.01),电针组进入隐藏区潜伏期时间较模型组显著缩短(P<0.01),电针组脑梗死率较模型组显著缩小(P<0.01),SYN的蛋白表达电针组较模型组明显增强(P<0.01)。假手术组无神经功能缺损及脑梗死灶,SYN表达最弱。结论 电针干预能减小脑梗死体积,上调脑内SYN的表达,进而促进缺血性脑卒中大鼠的记忆及运动等神经功能的恢复。  相似文献   
7.
目的:探讨MR对PRES的临床诊断价值。方法应用3.0 T MR对30例PRES患者进行常规扫描,其中19例同时行MRA检查,13例行MRV检查。结果 PRES病变主要累及顶枕叶,双侧基本对称;病变主要位于脑白质内,也可累及其它部位。PRES病变的特点是呈长T 1长T 2信号,边缘不清,无明显占位效应。MRA及MRV均无异常发现。结论 MR对PRES可以作出准确诊断,对临床有重要的指导意义。  相似文献   
8.
9.
The rise in popularity of hyaluronic acid (HA) dermal filler injection has caused an exceptional increase in the number of cases of reported irreversible blindness. Here, we reported a case of ischemic optic neuropathy and ophthalmoplegia following subcutaneous HA filler injection with complete visual recovery. A 31-year-old Chinese woman presented with sudden onset of right monocular visual impairment associated with diplopia. Patient had received a hyaluronic acid-containing ?ller injection for nasal dorsum augmentation twelve hours prior to presentation. Visual acuity of the right eye was counting finger. A right relative afferent pupillary defect was demonstrated with ophthalmoplegia. Humphrey visual field test disclosed a right inferior altitudinal field defect with impairment of colour vision. Computed tomography of the orbit revealed mild enlargement of the right medial and inferior recti muscles. Our patient showed a tremendous improvement of vision after a subcutaneous hyaluronidase injection with complete visual recovery within 2 weeks.  相似文献   
10.
BackgroundPeriodontitis is associated with the pathogenesis of atherosclerotic plaque, and hypersensitive C reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) are the serum biomarkers of the stability of atherosclerotic plaque. Whether periodontitis is associated with the serum level of hs-CRP and Lp-PLA2 of acute ischemic stroke remains unclear.Material and MethodsWe recruited 103 cases with acute ischemic stroke within 7 days after stroke onset. Pocket depth and clinical attachment loss were assessed by oral examination to define the severe periodontitis. Demographic information including gender, age and body weight index, income level, education level, past medical history include smoking history, drinking history, ischemic stroke history, coronary heart disease, hypertension, diabetes and hyperlipidemia were collected, and serum biomarkers including white blood cell (WBC), fibrinogen, total cholesterol (TC), triglyceride (TG), lower density lipoprotein (LDL-C), high density lipoprotein (HDL-C), hs-CRP, HemoglobinA1c (HbAlc), Homocysteine (HCY) and Lp-PLA2 were tested.Results65 (63.1%) cases were diagnosed as severe periodontitis. Severe periodontitis group showed more male, age, drinking history, higher levels of hs-CRP and Lp-PLA2. Multivariate logistic regression showed that severe periodontitis was were significantly associated with hs-CRP (OR = 2.367, 95%CI: 1.182–4.738; P = .015) and Lp-PLA2 (OR = 2.577, 95% CI: 1.010–6.574; P = .048).ConclusionsSevere periodontitis is independently associated with the serum Level of hs-CRP and Lp-PLA2 in patients with acute ischemic stroke. Whether the improvement of periodontitis could decrease the occurrence and re-occurrence of ischemic stroke by stablizating atherosclerotic plaque need be further studied in future.  相似文献   
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