Objective To summarize the experience chest small incision closure of atrial septal defects treatment,evaluation of the efficacy and safety of operation.Methods Eight patients with secondary pore pathogenesy,atrial septum defect size 16-45 mm,take right next to the sternum surgery incision between 3 or 4 ribs 3-4 cm,in the cardiac ultrasound guided into occluder.Results All successful surgery,no postoperative shunt and abnormal,1 huge successful closure of atrial septal defect in 45mm.Conclusion After transcatheter closure of atrial septal defect with small incision in the chest,easy,small trauma,recover fast,safe and reliable.

Objective To evaluate the relationship between stenosis of intra- or extra-cranial cerebral large artery and capsular warning syndrome(CWS). Methods Eleven consecutive CWS patients hospitalized during period of time from November 2008 to December 2009 were retrospectively analyzed.Result In these 11 patients with CWS, 5 patients had motor symptoms only, 4 patients had pure sensory symptoms, and 2 patients had sensorimotor symptoms. Ten patients underwent cervical contrast-enhanced MRA and intracranial MRA examination. The results showed no sign of arterial stenosis. Seven CWS patients eventually had strokes, 1 progressed to stroke despite receiving the therapy of antiplatelet and anticoagulation. All stroke lesions were located in the capsula interna. All the CWS patients had vascular risks: 7 were smoker, 8 had hypertension, 1 had diabetes mellitus, and 5 had hyperlipidemia. One patient had a history of previous stroke; no patient had a history of ischemic heart disease or atrial fibrillation. At follow-up(10. 2 ±3.4)mouths, the average modified Rankin scale score for all patients was 0. 73 ± 1.20.Conclusion CWS was not associated with stenosis of the intra and extra-cranial large cerebral arteries.CWS may be associated with small-vessel single-penetrator disease.

Objective To investigate the impact of the pretreatment perfusion weighted imaging (PWI)-diffusion weighted imaging (DWI) mismatch on reperfusion and early neurological improvement after intravenous thrombolysis in acute ischemic stroke.Methods We retrospectively reviewed our collected clinical,laboratory,and radiologic data in patients receiving intravenous recombinant tissue plasminogen activator therapy,who had performed multimodal MRI in both pretreatment and 24 h post-treatment in our hospital..The target mismatch of PWI-DWI was defined as a PWI lesion that was 10 ml or more and 120％ or more of the DWI lesion,with DWI lesion less than 70 ml and PWI lesion less than 140 ml.The smalllesion was defined as a DWI and PWI volume both less than 10 ml.The others were termed non-target mismatch.Reperfusion required a 30％ or greater reduction in PWI lesion volume on the 24-hour follow-up scar.The early neurological improvement was defined as the patients with an NIHSS score of 0 to 4 or 6-point or greater improvement at 7 days.Results Among 45 patients analyzed,19(41％) patients presented target mismatch,of which 8 patients were treated over 4.5 h.The rate of reperfusion and early neurological improvement after thrombolysis in target mismatch group were both significantly increased comparing with non-target mismatch group( 16/19 vs 5/12,x2 =6.092,P ＜0.05 and 13/19 vs 2/12,x2 =7.888,P ＜ 0.05,respectively ),although the recanalization rate demonstrated no significant difference between two groups.The pooled OR for reperfusion was 6.4(95％ CI 1.156-35.437,P =0.034),and the pooled OR for favorable clinical response was 21.7 ( 95％ CI 2.234-210.110,P =0.008 ) in target mismatch patients.Among the target mismatch group,13/16 of patients with reperfusion had early neurological improvement,while no patients without reperfusion had neurological improvement.The rate of recanalization,reperfusion and neurological improvement after thrombolysis demonstrated no significant difference between target mismatch group treated within 4.5 h and beyond 4.5 h.Conclusion Patients with target mismatch profile before thrombolysis had a high reperfusion rate and were prone to get early neurological improvement,indicating that the evaluation of PWI-DWI mismatch may facilitate the selection of patients who may benefit from thrombolysis beyond the time window.

Nowadays, health care products based on static magnetic fields (SMF) and merchandise of magnetic therapy are popular around the world. But the biomedical effects of SMF to animals or human beings remain a widely concerned controversy. In this paper, the recent researches in China and abroad about the biomedical effects of SMF were reviewed in three levels: the cellular, animal and human levels. Nevertheless, these data were not consistent with each other and even some contradicts others' researches. So, it is necessary to do more and further studies on SMF dosing regiman, sham control magnetic device and blinding procedures to obtain the optimal magnetic intensity, the desired therapeutic effects in practical cases and prepare for applying the SMF in biomedical fields more effectively in the future.
Animals ; Humans ; Magnetic Field Therapy ; methods ; Magnetic Fields ; Neoplasms ; therapy ; Pain ; prevention & control

OBJECTIVE: To investigate the effect of working time on the prognosis of patients with ischemic stroke undergoing intravenous thrombolysis. METHODS: Clinical data of 3050 patients with ischemic stroke received intravenous thrombolysis from 71 hospitals in Zhejiang Province during June 2017 and September 2018 were retrospective analyzed. Whole day of Saturday and Sunday were defined as weekend; whole day of Monday to Friday were defined as weekdays; Monday to Friday 8:00-17:00 were defined as daytime of weekdays; Monday to Friday 17:01-07:59 on next day were defined as nights of weekdays; unconventional working time were defined as weekend and nights of weekdays. Good outcome was defined as mRS 0-2 at 3 months. Univariate analyses of baseline and prognostic variables in group of weekend and weekdays, nights of weekdays and daytime of weekdays, unconventional working time and daytime of weekdays were performed. Binary logistic regression was used to investigate whether weekend, nights of weekdays and unconventional working time were independent predicting factors of outcome after intravenous thrombolysis, respectively. RESULTS: There was no difference in 7-day mortality, 3-month mortality and good outcome at 3-month between weekend group and weekdays group, nights of weekdays group and daytime of weekdays group, unconventional working time group and daytime of weekdays group (all >0.05). Binary logistic regression results showed that weekends, nights of weekdays and unconventional working time were not independent predicting factors for outcome after intravenous thrombolysis (all >0.05). CONCLUSIONS The working time has not affected the outcomes of patients with ischemic stroke undergoing intravenous thrombolysis in studied hospitals of Zhejiang province.
Brain Ischemia ; drug therapy ; Humans ; Prognosis ; Retrospective Studies ; Stroke ; drug therapy ; Thrombolytic Therapy ; Time Factors

OBJECTIVE: To compare the time delay between in-hospital stroke and out-of-hospital stroke patients, and to explore the influence factors for the prognosis of in-hospital stroke patients treated by intravenous thrombolysis. METHODS: Clinical data of 3050 patients with ischemic stroke who received intravenous thrombolysis in 71 hospitals in Zhejiang province from June 2017 to September 2018 were analyzed. Differences of time delay including door to imaging time (DIT), imaging to needle time (INT) and door to needle time (DNT) between in-hospital stroke (=101) and out-of-hospital stroke (=2949) were observed. The influencing factors for the outcome at 3 month after intravenous thrombolysis in patients with in-hospital stroke were analyzed using binary logistic regression analysis. RESULTS: Patients with in-hospital stroke had longer DIT[53.5 (32.0-79.8) min vs. 20.0 (14.0-28.0) min, <0.01], longer IDT[47.5(27.3-64.0)min vs. 36.0(24.0-53.0)min, <0.01], and longer DNT[99.0 (70.5-140.5) min vs. 55.0 (41.0-74.0) min, <0.01], compared with patients with out-of-hospital stroke; patients in comprehensive stroke center had longer DIT[59.5(44.5-83.3) min vs. 37.5(16.5-63.5) min, <0.01], longer DNT[110.0(77.0-145.0) min vs. 88.0 (53.8-124.3) min, <0.05], but shorter INT[36.5(23.8-60.3)min vs. 53.5 (34.3-64.8) min, <0.05], compared with patients in primary stroke center. Age (=0.934, 95% 0.882-0.989, <0.05) and baseline National Institute of Health Stroke Scale score (=0.912, 95% 0.855-0.973, <0.01) were independent risk factors for prognosis of in-hospital stroke patients. CONCLUSIONS In-hospital stroke had longer DIT and DNT than out-of-hospital stroke, which suggests that a more smooth thrombolysis process of in-hospital stroke should be established.
Administration, Intravenous ; Brain Ischemia ; drug therapy ; Fibrinolytic Agents ; therapeutic use ; Hospitals ; statistics & numerical data ; Humans ; Prognosis ; Stroke ; drug therapy ; Thrombolytic Therapy ; statistics & numerical data ; Time Factors ; Treatment Outcome

OBJECTIVE: To investigate the effect of treatment time on the outcome of patients with ischemic stroke undergoing reperfusion therapy. METHODS: The clinical data of 3229 ischemic stroke patients who received intravenous thrombolysis with or without arterial thrombolysis from 71 hospitals in Zhejiang province from June 2017 to September 2018 were retrospectively reviewed. The good outcome was defined as modified Rankin Scale (mRS) ≤ 2. Binary logistic regression analysis was used to investigate the association of door to needle time (DNT), or door to reperfusion time (DRT) with the outcomes in patients treated by intravenous thrombolysis or bridging arterial thrombolysis, respectively. RESULTS: Binary logistic regression showed that DNT (=0.994, 95%:0.991-0.997, <0.01) or DRT (=0.989, 95%:0.983-0.995, <0.01) were independently associated with good outcomes, respectively. Every hour decreases in DNT resulted in a 4.7%increased probability of functional independence (mRS 0-2) in patients treated by intravenous thrombolysis; Every hour decreases in DRT was associated with a 11.4%increased probability of functional independence in patients treated by intravenous thrombolysis with arterial thrombolysis. CONCLUSIONS Good outcomes are associated with lower DNT in ischemic stroke patients treated by intravenous thrombolysis or lower DRT in patients treated by intravenous thrombolysis bridging arterial thrombolysis.
Brain Ischemia ; drug therapy ; Fibrinolytic Agents ; therapeutic use ; Humans ; Reperfusion ; Retrospective Studies ; Stroke ; drug therapy ; Thrombolytic Therapy ; Time Factors ; Treatment Outcome

OBJECTIVE: To investigate the effect of emergency medical service (EMS) on the prognosis of ischemic stroke patients treated with intravenous thrombolysis. METHODS: Clinical data of 2123 ischemic stroke patients treated with intravenous thrombolysis in 70 hospitals in Zhejiang province were retrospectively analyzed. There were 808 patients sent to the hospital by ambulance (EMS group) and 1315 patients by other transportations (non-EMS group). Good outcome was defined as modified Rankin Scale (mRS) ≤ 2 at 3-month. The onset to needle time (ONT), onset to door time (ODT), door to needle time (DNT) and outcome were compared between EMS group and non-EMS group. Binary logistic regression was used to explore the influencing factors for the outcome at 3-month. RESULTS: Compared with the non-EMS group, patients in the EMS group were older, with higher baseline National Institute of Health Sroke Scale (NIHSS) score, and had a higher proportion of atrial fibrillation (all <0.05), but there were no significant differences in ONT, ODT and DNT between two groups (all >0.05). Binary logistic regression showed that EMS was not independently associated with good outcome (=0.856, 95%:0.664-1.103, >0.05). CONCLUSIONS EMS had not improve the outcome of patients receiving intravenous thrombolysis in Zhejiang province.
Administration, Intravenous ; Brain Ischemia ; drug therapy ; Emergency Medical Services ; Fibrinolytic Agents ; therapeutic use ; Humans ; Prognosis ; Retrospective Studies ; Stroke ; drug therapy ; Thrombolytic Therapy ; statistics & numerical data ; Treatment Outcome

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.