Objective To investigate the risk factors of early recovery in patients with ischemic stroke(IS).Methods 168 patients with IS received the conventional treatment and early rehabilitation were enrolled in the study.Single factor analysis was used to analyze the risk factors of the IS in the early treatment of rehabilitation in patients with and without success recovery rehabilitation success,and then application (unconditional Logistic regression analysis factors early independent risk factors for healing.Results Single factor analysis shows that age quartile (60years old),history of hypertension,coronary heart disease,diabetes,history,history of smoking history,anxiety and depression and successful rehabilitation negatively,life,education degree by law quartile (12 years) and mental work positively correlated with successful recovery.Many factors analysis shows that education degree by quartile (12)(OR=0.12,95％ 00.03 to 0.75),mental workers (OR=0.45,95％ CI 0.37 to 0.47) is the success of the recovery protection factor (P＜0.05),And age quartile (60) ( OR=2.12,95％ CI 1.21 to 3.21 ),anxiety ( OR =2.64,95％ CI 1.82 to 6.11 ) and depression (OR =1.45,95％ CI 1.13 to 1.96) is the success of the recovery independent risk factors (P ＜ 0.05 ).Conclusion Age quartile (60),anxiety and depression are IS successful independent risk factors for the recovery of the patients with early rehabilitation IS the risk factors should undertake the necessary intervention.

This paper summarized the clinical experience of using the method of “returning fire to its origin” for treatment of paroxysmal sympathetic hyperactivity （PSH）. According to the causes and clinical characteristics of PSH， the author believes that the deficiency of kidney qi， and the loss of yin and yang are the basis of the pathogenesis of PSH. Fright causes qi to be chaotic as the triggering mechanism of PSH. The key mechanism of PSH is that the deficiency yang with upper manifestation， and the fire does not return to its origin. The treatment should be nourishing yin and astringing yang， by taking modified Yinhuo Decoction （引火汤） internally， and receiving warm moxibustion as the first choice externally with selected acupoints Guanyuan （CV 4）， Mingmen （GV 4）， and bilateral Yongquan （KI 1）； For prevention， attention should be paid to take care of stomach qi， support healthy qi， and cultivate original qi.

Objective: To explore the clinical characteristics of the complication of brain abscesses after cerebrospinal fluid rhinorrhea repairment. Methods: A retrospective analysis was conducted on 149 patients undergone endoscopic repairment of cerebrospinal fluid rhinorrhea from October 2007 to October 2017 in Department of Otorhinolaryngology Head and Neck Surgery, Tianjin HuanHu Hospital. The clinical characteristics and treating methods of 3 brain abscess cases were analyzed. Results: Of the 149 patients accepted the endoscopic repairment of cerebrospinal fluid rhinorrhea, 3 cases were complicated with postoperative brain abscesses, which showed as frontal lobe abscess by strengthened head MRI. The incidence of abscess was 2.0%. Abscess formation time was within 10 d after surgery. One case was treated with antibiotic and reducing intracranial pressure, while other 2 cases were treated with puncture drainage. After following-up of 1 to 24 months, these 3 cases had no recurrence of cerebrospinal fluid rhinorrhea or abscess. Conclusions The complication of brain abscess formation after endoscopic repairment of cerebrospinal fluid rhinorrhea is more common in frontal lobe, which may take place within 7-10 d postoperatively. Conservative treatment is the first choice. Under the condition of obvious symptoms and pus cavity fusion, puncture drainage can be performed.

Humans ; Pituitary Neoplasms

Objective　We used proteomics technologies in an attempt to differentiate and identify histological proteins that were associated with carotid atherosclerotic plaques and further understanding of the pathogenesis. Methods　Carotid atherosclerotic plaques were obtained from the patients who undergo carotid endarterectomy in the Tianjin Huanhu Hospital. Plaques divided into two groups：stable group and unstable group. We comparatively analyzed the proteome of 10 unstable plaques and 10 stable plaques. The differentially expressed proteins were visualized by two dimensional electrophoresis（2DE）and were analyzed by a coupled label-free and mass spectrometry approach. The protein identification program was used to search the Uniprot. Results　A total of 1240 different proteins were identified by label-free and mass spectrometry. A total of 808 proteins were upregulated，and 432 proteins were downregulated in unstable plaques group compared to stable plaques group. They are referring to signal transduction，lipid transport and metabolism，posttranslational modification，cytoskeleton and Proteolysis. Conclusion　Proteomics analysis can be used to investigated differentially expressed proteins. However，Additional confirmatory studies are required to elucidated their role in the atherosclerotic process.

Brachiocephalic Trunk ; Fistula/surgery* ; Humans ; Trachea ; Tracheostomy

OBJECTIVETo Analyze the influence factors on the complications of percutaneous dilational tracheotomy.

METHODSBetween August 2008 and February 2014, there were 3 450 patients with the indications of tracheotomy accepted percutaneous dilational tracheostomy, mainly using percutaneous dilational and percutaneous guide wire forceps in these cases. Statistical analysis was performed by SPSS 19.0 software on postoperative complications, the possible influence factors including age, gender, etiology, preoperative hypoxia, obesity, preoperative pulmonary infection, state of consciousness, operation method, operation doctor and whether with tracheal intubation.

RESULTSAmong 3 450 patients, there were 164 cases with intraoperative or postoperative complications, including postoperative bleeding in 74 cases (2.14%), subcutaneous emphysema in 54 cases (1.57%), wound infection in 16 cases (0.46%), pneumothorax in 6 cases (0.17%), mediastinal emphysema in 5 cases (0.14%), operation failed and change to conventional incision in 4 cases (0.12%), tracheoesophageal fistula in 2 cases (0.06%), death in 3 cases(0.09%).Obesity, etiology, preoperative hypoxia, preoperative pulmonary infection, state of consciousness and operation method were the main influence factors, with significant statistical difference (χ(2) value was 0.010, 0.000, 0.002, 0.000, 0.000, 0.000, all P < 0.05). Gender, age, operation doctor and whether there was the endotracheal intubation were not the main influence factors. There was no significant statistical difference (P > 0.05).

CONCLUSIONAlthough percutaneous dilational tracheostomy is safe, but the complications can also happen. In order to reduce the complications, it is need to pay attention to the factors of obesity, etiology, preoperative hypoxia, preoperative pulmonary infection, state of consciousness and operation method.

Humans ; Intubation, Intratracheal ; Postoperative Complications ; epidemiology ; Subcutaneous Emphysema ; Surgical Instruments ; Tracheoesophageal Fistula ; Tracheostomy ; Tracheotomy ; methods ; statistics & numerical data

Objective: To analyze the activation of brain regions associated with olfactory in patients with mild cognitive impairment (MCI) by olfactory functional magnetic resonance imaging (fMRI). Methods: Twenty six patients with MCI were compared with twenty six controls in the dementia center of Tianjin HuanHu hospital in terms of olfactory function T&T testing, the differences between the activation of the whole brain and region of interest associated with olfactory (bilateral primary olfactory cortex(POC), bilateral hippocampus, bilateral orbital frontal gyrus) by olfactory stimulator using event correlation design for olfactory fMRI scanning. To analyze the correlation between the number of activator in POC and the threshold of olfactory discriminate as well as the severity of cognitive impairment.SPSS 19.0 software was used for the statistical analysis. Results: T&T olfactory testing revealed that MCI patients had higher scores than controls (3.57±1.29 (±s) vs 1.02±0.35, t=4.372, P<0.05). The activation range of whole brain in MCI patients was less than controls (pleasant odor (po) 147.36±21.45 vs 323.11±39.76, unpleasant odor (upo) 201.86±24.93 vs 447.73±57.22, t_po=4.241, t_upo=5.365, both P<0.05). The activation range of whole brain in inhaling unpleasant odor was more than pleasant odor in controls (447.73±57.22 vs 323.11±39.76, t=3.936, P<0.05). The number of activator in ROI_awo in MCI patients was less than controls (pleasant odor (po) 51.0[8.0, 109.0](M[P₂₅, P₇₅]) vs 135.0[21.0, 321.5], unpleasant odor (upo) 65.0[6.0, 158.0]vs 205.0[36.5, 491.0], Z_po=-2.199, Z_upo=-2.216, both P<0.05). The number of activator in POC in MCI patients was less than controls (pleasant odor (po) 19.0[4.0, 35.5]vs 46.0[9.0, 118.5], unpleasant odor (upo) 26.0[2.0, 51.0]vs 79.0[17.5, 189.0], Z_po=-1.898, Z_upo=-2.167, both P<0.05). The number of activator in POC was negatively correlated with olfactory discriminate threshold in MCI patients (r_po=-0.415, r_upo=-0.409, both P<0.05). The number of activator in POC was positively correlated with MoCA in MCI patients (r_po=0.289, r_upo=0.296, both P<0.05). Conclusion Olfactory fMRI can objectively assess the olfactory function in MCI, it is a imaging indicator with neuropsychological tests for detection in MCI, the number of activator in POC can reflect the severity of MCI.

Objective: To indicate the clinical features of endoscopic transnasal resection of epidural cholesteatoma at paracentral skull base and to analyze its efficacy. Methods: The total excision rate, postoperative complications and postoperative curative effect of 7 patients (4 males and 3 females, aging from 32 to 63 years old) who underwent middle skull base surgery for epidural cholesteatoma resection under transnasal endoscope at Tianjin Huanhu Hospital between August 2017 and August 2020 were retrospectively reviewed. All patients were followed up for 6 to 36 months. The postoperative MRI, clinical symptoms and recurrence were reviewed. Descriptive statistical methods were used for analysis. Results: Among the 7 patients, there were total resection (complete resection of cyst contents and capsule) in 4 patients, near-total resection (complete resection of cyst contents, incomplete resection of cyst capsule) in 1 patient, and subtotal resection (incomplete resection of cyst contents and capsule) in 2 patients. The clinical symptoms of all patients were improved postoperatively with 1 patient who had no clinical symptoms. One case had postoperative cerebrospinal fluid rhinorrhea, which was cured after lumbar drainage and nasal iodoform gauge packing. Up to now, 7 patients (including patients with partial resection) had no recurrence. Conclusion: Endoscopic transnasal approaches may be effectively used for resection of epidural cholesteatoma in the paracentral skull base in carefully selected cases.
Adult ; Cholesteatoma ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Retrospective Studies ; Skull Base/surgery*

Objective: To investigate the related factors and treatments of delayed cerebrospinal fluid rhinorrhea (CFR) after invasive pituitary adenoma (IPA) surgery. Methods: One hundred and forty-two patients with IPA treated in Tianjin Huanhu Hospital from January 2014 to January 2019 were analyzed retrospectively, including 62 males and 80 females, aging from 38 to 67 years. The clinical data of patients before and after operation were collected. All patients with postoperative CFR underwent endoscopic CFR repair. During the operation, residual or recurrent pituitary adenomas were resected, the dura around the leak was enlarged and the necrotic tissue was removed. For those who still had fluid leakage after repair, the necrotic tissue was cleaned up, the leakage was filled and reinforced under endoscopy. Endoscopic rhinorrhea repair was performed if necessary. The cerebrospinal fluid leak was repaired with multi-layer materials. The related risk factors of delayed CFR after operation were analyzed. SPSS 19.0 software was used for statistical analysis. Results: Among the 142 patients in this group, 64 cases underwent total tumor resection and 78 cases underwent non-total tumor resection. They were followed up for 6 to 72 months. Thirty-one cases had delayed CFR, with an incidence of 21.83%, and occurred between 1 and 5 years postoperatively, with an average of 2.4 years. All 31 patients with delayed CFR underwent endoscopic CFR repair. The nasal endoscopy was rechecked at 2 weeks, 1 month, 3 months and 6 months after operation. Twenty-eight patients were repaired successfully after 1 operation, while 2 patients after 2 operations and 1 patient after 3 operations. These patients were followed up for 6 to 60 months, and no CFR occurred again. Univariate analysis showed that the degree of tumor resection, recurrence, size, texture, postoperative radiotherapy and operator experience were the risk factors of delayed CFR (all P<0.05). Multivariate analysis showed that the degree of tumor resection and recurrence were the highest independent risk factors for postoperative CFR, and tumor size, texture, postoperative radiotherapy and operator experience were the independent risk factors in this study. Conclusions: Delayed CFR after IPA is related to the degree of tumor resection, recurrence, size, texture, postoperative radiotherapy and the operator experience. It is necessary to completely remove the tumor under endoscope, to expand resection of the dura and necrotic tissue around the leak, to repair the defect with multi-layer materials, to follow-up closely and to repair timely after operation.
Adenoma/surgery* ; Adult ; Aged ; Cerebrospinal Fluid Leak ; Cerebrospinal Fluid Rhinorrhea/surgery* ; Female ; Humans ; Male ; Middle Aged ; Pituitary Neoplasms/surgery* ; Retrospective Studies