Objective To analyze the reasons for the perioperative death of endovascular repair of acute aortic dissection （AD）. Methods The clinical data of 176 patients with acute AD and received endovascular repair from July 2001 to October 2012 were analyzed retrospectively. Results Among 176 patients with acute AD， 8 patients died during perioperatively， received endovascular repair in 1-5 days after admission （mean 2.4 d）， and all of them admitted before 2008. Two cases were type A and 6 cases were type B. All cases with hypertension and 3 cases with pleural effusion. Three cases died on the day of operation， among them 2 cases occurred in 1 h after operation， the other 1 case occurred in 2 h after operation. Four cases died in 2 days after operation and 1 case died in 4 days after operation. Four cases died of rupture of the aortic dissection， 2 cases died of cerebral infarction， 1 case died of multiple organ failure， and 1 case died of gastrointestinal bleeding. Conclusion To avoid performing endovascular repair during the acute phase and improving operation skills may help to avoid the occurrence of perioperative death.
ObjectiveTo observe systemic inflammatory response (SIR)of patients in different stages after the onset of aortic dissection (AD), and preliminarily explore a new staging system of AD based on SIR. MethodsFrom September 2011 to February 2012, 46 AD patients were admitted to the Department of Cardiovascular Surgery, West China Hospital of Sichuan University. There were 33 male and 13 female patients with their age ranging from 22 to 77 years (53.2±13.6 years). Blood samples were collected in 9 different periods after the onset of AD (0-12 hours (T1), 12-24 hours (T2), 24-48 hours (T3, 1-2 days), 48-96 hours (T4, 2-4 days), 96-168 hours (T5, 4-7 days), 168-336 hours (T6, 7-14 days), 336-720 hours (T7, 14-30 days), 720-1440 hours (T8, 30-60 days) and > 1 440 hours (T9, > days))to measure blood concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), endotoxin (ET), white blood cell (WBC)and neutrophils (Neut). SIR changes after the onset of AD were summarized. ResultsBlood concentrations of different inflammatory mediators were all significantly elevated within 14 days (T1-T6), significantly decreased in 14-60 days (T7-T8), and returned to normal range 60 days (T9)after the onset of AD. Peak levels of ET and TNF-α appeared in T1 with 263.42±29.98 pg/ml and 86.75±18.83 pg/ml respectively. Peak level of IL-6 appeared in T2 with 95.70±22.64 pg/ml. Peak level of CRP appeared in T5 with 123.74±54.78 mg/L. There was no obvious peak level of WBC or Neut. ConclusionDisease progression of AD can be divided into 3 stages including acute stage (within 14 days), subacute stage (14-60 days)and chronic stage ( > 60 days)based on the degree of SIR.
Objective To study the risk factors of urinary incontinence in acute stroke patients and provide scientific evidence for preventing and managing such complication. Methods A computerized literature search was performed on both English and Chinese databases including Embase, Medline, Wanfang Data, VIP, and CNKI from January 1990 to January 2017 based on such search strategies as literature review and manual retrieval. In addition, we tracked down the related reference lists. The RevMan 5.3 software was used for Meta-analysis. Categorical data were calculated by the pooled odds ratio (OR) values and 95% confidence intervals (CI), and numerical data were calculated by pooled mean difference (MD) and 95%CI. Results A total of 17 articles of controlled studies with 2 428 cases and 3 725 controls were included. According to the results of Meta-analysis, factors associated with urinary incontinence following acute stroke were age [MD=2.80, 95%CI (0.29, 5.30),P=0.03], female gender [OR=1.29, 95%CI (1.16, 1.45),P<0.000 01], diabetes [OR=1.40, 95%CI (1.13, 1.73),P=0.002], heart disease [OR=1.65, 95%CI (1.29, 2.13),P<0.000 1), former cerebrovascular disease [OR=1.43, 95%CI (1.21, 1.69),P<0.000 1), speech disorder [OR=4.20, 95%CI (3.45, 5.10),P<0.000 01], smoking [OR=0.68, 95%CI (0.50, 0.92),P=0.01]. Hypertension [OR=1.25, 95%CI (0.99, 1.58),P=0.06], left hemisphere involvement [OR=1.29, 95%CI (0.81, 2.06),P=0.29], and hemorrhagic stroke [OR=1.26, 95%CI (0.79, 2.03),P=0.33] were not correlated with urinary incontinence following acute stroke. Conclusions Older age, female gender, diabetes, heart disease, former cerebrovascular disease and speech disorder are risk factors associated with post-stroke urinary incontinence, while smoking lowers the potential risk. However, hypertension, hemorrhagic stroke and left hemisphere involvement do not significantly increase the risk of urinary incontinence following stroke.
ObjectivesTo evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) on the treatment for acute gout.MethodsPubMed, EMbase, The Cochrane Library, Epistemonikos, CBM, WanFang Data and CNKI databases were electronically searched to collect published systematic reviews and meta-analyses evaluating drug interventions therapy in acute gout from inception to April 8th 2017. Two reviewers independently screened literature, extracted data, assessed the methodological quality of included SRs by the AMSTAR tool, and assessed the quality of the body of evidence for each outcome by the GRADE approach.ResultsA total of seven relevant SRs were included, which contains three main outcome measures. Four SRs contained non-steroidal anti-inflammatory drugs (NSAIDS), three SRs contained colchicine and two SRs contained glucocorticoids. All SRs assessed risk of bias of included original studies. Two used the Jadad scale or modified Jadad scale in this assessment while others used the " assessing risk of bias” tool recommended by Cochrane Collaboration. The assessment results of AMSTAR tool suggested that: three SRs were considered high quality (scores≥9), and the other four were considered moderate quality. GRADE results showed: the quality of the evidence of 11 outcomes was low or very low, and five outcomes was moderate.ConclusionsThe current evidence confirms the effectiveness and safety of several drug interventions in the treatment of acute gout, however, the priority of these drugs is still unclear. We suggest conducting new SRs and updating relevant SRs, to systematically compare different drug interventions therapy in acute gout with the latest evidence. In addition, we still expect to put more efforts in conducting high-quality original studies, in order to fill the gap of relevant fields and improve the level of evidence quality.
Patients with acute human immunodeficiency virus (HIV) infection are the critical source of infection due to high viral load and strong transmission ability. The vast majority of patients in the acute infection stage have no or only mild clinical symptoms, and their screening and diagnosis often rely on laboratory tests. However, there are still some difficulties in early screening and detection for HIV infection due to the detection window period. In recent years, laboratory testing for acute HIV infection has made great progress. This article reviews the progress in laboratory testing of acute HIV infection, in order to provide a reference for follow-up related research.
目的 探討誘導痰、痰、血清中的白介素(IL)-4、-6、-8在慢性支氣管炎急性期的濃度閾值，確定其診斷意義，了解三種白介素在三種標本中的不同濃度對診斷慢性支氣管炎急性期的意義。 方法 2001年1月-8月對77例慢性反復咳嗽患者按全國慢性支氣管炎診斷標準確診慢性支氣管炎急性期48例，非慢性支氣管炎29例，進行IL-4、-6、-8的誘導痰、痰、血清檢測。采用受試者工作特征曲線(ROC曲線)鑒定三種白介素對三種標本的診斷價值。 結果 ①三種標本的三種白介素的診斷比值比(DOR)均＞3，95%可信區間的下限均＞1。②ROC曲線下面積顯示：誘導痰及痰中IL-4、-8之間無差別(P＞0.05)，IL-4和IL-8分別與IL-6之間有統計學意義(P＜0.05)；血清中IL-4、-6、-8檢測結果無差異(P＞0.05)。IL-4、-8的誘導痰及痰與血清有統計學意義(P＜0.05)，IL-6的誘導痰、痰、血清之間無差異(P＞0.05)。 結論 誘導痰及痰中的IL-4、-8診斷價值較好，可用于慢性支氣管炎急性期的診斷。
Objective To assess the quality of randomized controlled trials (RCTs) on acupuncture for treating acute migraine attacks. Methods With the searching terms of acupuncture and migraine, the Cochrane Controlled Trials Register (CCTR), PubMed, MEDLINE, EMbase, CBM, CMCC, CNKI and VIP were searched. The reports quality of the included trials, including the quality of methodology, diagnostic criteria, inclusion/exclusion criteria, acupuncture/control interventions, outcome measures, observing time, and adverse effects reports, was evaluated. Results A total 23 RCTs involving 2645 patients were included, of which only 3 RCTs were of high quality with Jadad scores equal to or more than 4. At present, only a few high quality trials on treating acute attacks of migraine with acupuncture had been reported at home and abroad. The international recognized diagnostic criteria and common evaluation methods had not been used generally, and the design of control was kind of irrational. Conclusion Based on current clinical reports, acupuncture may be effective in the management of acute migraine attacks, but some relevant proof is still required. The further domestic studies should be designed strictly following the international recommended diagnosis and evaluation criteria of migraine, and rational control methods as well.
Objective To establish and validate a risk prediction model for post-thrombotic syndrome (PTS) in patients after interventional treatment for acute lower extremity deep vein thrombosis (LEDVT). MethodsA retrospective study was conducted to collect data from 234 patients with acute LEDVT who underwent interventional treatment at Xuzhou Central Hospital from December 2017 to June 2022, serving as the modeling set. Factors influencing the occurrence of PTS were analyzed, and a nomogram was developed. An additional 98 patients from the same period treated at the Xuzhou Cancer Hospital were included as an external validation set to assess the reliability of the model. ResultsAmong the patients used to establish the model, the incidence of PTS was 25.2% (59/234), while in the validation set was 31.6% (31/98). Multivariate logistic regression analysis of the modeling set identified the following factors as influencing PTS: age (OR=1.076, P=0.001), BMI (OR=1.163, P=0.004), iliac vein stent placement (OR=0.165, P<0.001), history of varicose veins (OR=5.809, P<0.001), and preoperative D-dimer level (OR=1.341, P<0.001). These 5 factors were used to construct the risk prediction model. The area under the receiver operating characteristic (ROC) curve (AUC) of the model was 0.869 [95%CI (0.819, 0.919)], with the highest Youden index of 0.568, corresponding to a sensitivity of 79.7% and specificity of 77.1%. When applied to the validation set, the AUC was 0.821 [95%CI (0.734, 0.909)], with sensitivity of 77.4%, specificity of 76.1%, and accuracy of 76.6%. ConclusionsThe risk prediction model for PTS established in this study demonstrates good predictive performance. The included parameters are simple and practical, providing a useful reference for clinicians in the preliminary screening of high-risk PTS patients.
ObjectiveTo observe the dynamic changes of the concentrations of serum matrix metalloproteinase (MMP)-2 and MMP-9, and to discuss its clinical significance. MethodsFrom January to May 2014, 50 cases of clinically diagnosed cerebral infarction patients were included in the study as the cerebral infarction group, and we randomly selected 30 healthy volunteers at the same time in the same age group as the control group. The serum MMP-2 and MMP-9 of patients with acute cerebral infarction were detected in the onset of 24 hours, 7th day and 14th day respectively, which were compared with the control group accordingly. The patients with cerebral infarction were divided into small infarction group (1.5-3.0 cm), middle infarction group (3.1-5.0 cm) and large infarction group (>5.0 cm) according to the infraction volume. According to neurological functional deficit score they were divided into mild (0-15 points), moderate (16-30 points) and severe group (31-45 points). Changes of the level of MMP-9 and MMP-2 were compared in patients with different cerebral infarction volume and different impairment degree. ResultsFor the cerebral infarction group, the serum MMP-2 and MMP-9 levels were significantly higher in the onset of 24 hours, 7th day and 14th day[MMP-2:(2.36±0.76), (2.86±0.87), and (2.20±0.79) ng/mL; MMP-9:(238.8±99.6), (360.4±141.8), and (152.2±80.4) ng/mL] than the control group[MMP-2:(1.20±0.27) ng/mL; MMP-9:(124.8±28.2) ng/mL] (P<0.05). The larger the infarction volume was in the patients with acute ischemic stroke, the higher the levels of serum MMP-9 and MMP-2. The severer the neurologic impairment degree was in the patients with acute ischemic stroke, the higher the levels of serum MMP-9 and MMP-2 were. ConclusionFor patients with acute cerebral infarction, the levels of serum MMP-2 and MMP-9 are closely related to time of onset, infarct volume and neurological deficits, which can be used as an important basis to estimate the condition and assess the prognosis.