BACKGROUNDThe risk of clinical deterioration still exists in the acute phase despite the fact that patients with minor stroke may display less severe symptoms. The impact of this clinical deterioration on long-term outcomes is unknown. We characterized the clinical features of neurological deterioration (ND) in the acute phase of minor ischemic stroke (MIS) and investigated its impact on mid- and long-term outcomes.

METHODSThis was a multi-centered, prospective clinical study involving patients with MIS (the National Institutes of Health Stroke Scale, NIHSS ≤3) recruited from the China National Stroke Registry. Patients were included who had been hospitalized within 24 hours of stroke onset. Baseline characteristics, complication rates during hospitalization, etiology of stroke, as well as 3-, 6-, and 12-month post-stroke outcomes were compared between patients with and without ND during the acute phase.

RESULTSA number of 368 (15.2%) out of 2424 patients included in the study exhibited ND in the acute phase. Compared to patients without ND, patients with ND had longer hospital stay, increased rate of baseline diabetes, and multiple complications. Multivariate Logistic regression indicated that ND in acute phase was an independent factor predictive of increased dependence (adjusted odds ratio = 5.20, 95% CI, 3.51-7.70, P < 0.001) at 12-month post-stroke.

CONCLUSIONSThe risk of ND in the acute phase is high in patients with MIS. ND in the acute phase is an independent predictor for poor outcomes at 12 months post-stroke onset.

Aged ; China ; Female ; Humans ; Male ; Middle Aged ; Nervous System Diseases ; etiology ; physiopathology ; Prognosis ; Prospective Studies ; Risk Factors ; Stroke ; complications ; pathology

Objective To estimate the prevalence of overweight and obesity , and their relationship between overweight , obesity and chronic diseases among adults in Pinghu City . Methods A total of 3 106 local registered permanent residents aged above 18 years were selected by multi-stage random sam-pling and questionnaire surveys were conducted .The blood glucose , blood lipid , blood pressure , height and weight of the participants were tested . Results The prevalence rate of overweight was 31 .6%( the standardized rate was 29 .5%) and the prevalence rate of obesity was 8 .1% ( the standardized rate is 7 .8%) in residents aged above 18 years in Pinghu City .The prevalence rate of overweight and obesity was highest among population aged from 50 to 59 years.The prevalence rates of overweight of the population in different ages and with different education backgrounds had significant differences ( P <0.05 ).The prevalence rates of diabetes , hypertension and dyslipidemia among overweight and obese population were higher than those with normal weight ( P <0 .01 ) .BMI was the risk factor of hypertension , diabetes mellitus and dyslipidemia , and the OR value was 1 .508 , 2 .127 and 1 .571 , respectively . Conclusion The prevalence of overweight and obesity in Pinghu City is serious and has close relation with chronic diseases .Prevention and intervention measures are necessary for the overweight and obesity population .

BACKGROUNDNoninvasive positive pressure ventilation (NIPPV) has been proposed to shorten the duration of mechanical ventilation in intubated patients, especially those who fail initial weaning from invasive mechanical ventilation (IMV). However, there are also some discrepancies in terms of weaning success or failure, incidence of re-intubation, complications observed during study and patient outcomes. The primary objective of this update was to specifically investigate the role of NIPPV on facilitating weaning and avoiding re-intubation in patients intubated for different etiologies of acute respiratory failure, by comparing with conventional invasive weaning approach.

METHODSWe searched randomized controlled trials (RCTs) comparing noninvasive weaning of early extubation and immediate application of NIPPV with invasive weaning in intubated patients from PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Knowledge and Springerlink databases. Records from conference proceedings and reference lists of relevant studies were also identified.

RESULTSA total of 11 RCTs with 623 patients were available for the present analysis. Compared with IMV, NIPPV significantly increased weaning success rates (odds ratio (OR): 2.50, 95% confidence interval (CI): 1.46 - 4.30, P = 0.0009), decreased mortality (OR: 0.39, 95%CI: 0.20 - 0.75, P = 0.005), and reduced the incidence of ventilator associated pneumonia (VAP) (OR: 0.17, 95%CI: 0.08 - 0.37, P < 0.00001) and complications (OR: 0.22, 95%CI: 0.07 - 0.72, P = 0.01). However, effect of NIPPV on re-intubation did not reach statistical difference (OR: 0.61, 95%CI: 0.33 - 1.11, P = 0.11).

CONCLUSIONSEarly extubation and immediate application of NIPPV is superior to conventional invasive weaning approach in increasing weaning success rates, decreasing the risk of mortality and reducing the incidence of VAP and complications, in patients who need weaning from IMV. However, it should be applied with caution, as there is insufficient beneficial evidence to definitely recommend it in terms of avoiding re-intubation.

Humans ; Randomized Controlled Trials as Topic ; Respiration, Artificial ; methods ; Ventilator Weaning ; methods

OBJECTIVETo study the effect of energy therapy on Ca2+ concentration and Ca2+ -ATP enzyme activity in rat master muscle after unilateral chew, and to discuss the protective action of the exogenous creatine phosphate on rat masseter muscle after unilateral chew.

METHODSThe 20 rats were randomly divided into 4 groups, A: Creatine phosphate normal control group; B: Creatine phosphate experimental group; C: Saline normal control group; D: Saline experimental group. The Ca2+ concentration were determined by atomic absorption spectrophotometry, the activity of the Ca2+ -ATP enzyme were determined by super-micro volume Ca2+ -ATP enzyme kit.

RESULTS(1) The Ca2+ concentration of the extraction side of group D which received the saline injection had significant difference compared with the non-extraction side (P = 0.007), the group C (P = 0.009) and the extraction side of group B (P = 0.01); (2) Ca2+ -ATP enzyme activity of group D were higher than its non-extraction side (P = 0.001), group C (P = 0.003) and the extraction side of group B (P = 0.001); (3) The ultrastructural changes of the rat masseter muscle under transmission electron microscope were as follows: The extraction side of group D have more severe pathological manifestations than non-extraction side. Both the extraction side and the non-extraction side of group B had a similar manifestation to the normal control group.

CONCLUSIONExogenous energy material, creatine phosphate, may have certain degree of protective effect on rat masseter muscles after unilateral chew. And it may become a possible way to improve the injury of the masseter muscle.

Animals ; Calcium ; metabolism ; Calcium-Transporting ATPases ; metabolism ; Masseter Muscle ; physiopathology ; ultrastructure ; Mastication ; Microscopy, Electron, Transmission ; Phosphocreatine ; pharmacology ; Rats

Diagnostic Errors ; Humans ; Lung Diseases, Fungal ; diagnosis ; drug therapy ; pathology ; Male ; Middle Aged ; Mucormycosis ; diagnosis ; drug therapy ; pathology ; Radiography, Thoracic ; Tomography, X-Ray Computed

OBJECTIVETo assess the therapeutic effect and safety of electroacupuncture (EA) at Zhigou (TE 6) on constipation induced by stagnation or deficiency of qi.

METHODSMulti-central randomized controlled trials were adopted and the patients conforming to the criteria for diagnosis, enrolling and excluding were divided into an observation group and a control group according to random number table. The observation group were treated with EA at Zhigou (TE 6) and the control group with EA at non-acupoint for 4 weeks. The cumulative score of clinical symptoms, colon transmission test and various safety indexes were assessed. The following-up was carried out 1 and 3 months after the end of treatment.

RESULTSEA at Zhigou (TE 6) could obviously improve clinical symptoms and colon transmission time, decrease using rate of Kaisailu and cathartics, with an effective rate of 94.4%, which was better than 61.3% in the control group (P < 0.0001).

CONCLUSIONEA at Zhigou (TE 6) has a function of regulating qi and relaxing the bowels and it is an effective method for treatment of constipation with safety and no adverse effect.

Acupuncture Points ; Adult ; Aged ; Constipation ; therapy ; Electroacupuncture ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Qi

OBJECTIVETo study the mechanism in masticatory muscle dysfunctional induced by hemimastication.

METHODSCa2+ contents were measured with atomic absorption spectrometry; calcinuerin were measured with colorimetric method; muscle fiber types were measured with adenosine-triphosphate (ATPase) staining.

RESULTS(1) Compared with the controls, Ca2+ contents in experimental group had the higher level except 8 weeks (P < 0.05). (2) The ratio of slow fiber in experimental group increased, higher than the match groups (P < 0.05). (3) With Ca2 contents rise, the activities of calcinuerin present a bell-like shape. (4) The ratio of slow-type fiber was positively correlated to the activities of calcinuerin (r = 0.876, P < 0.05).

CONCLUSIONThe signal way of muscle fiber growth and fiber transformation were activated by high concentration of calcium, then, muscle fiber transferred from fast to slow type. It may play an important role in the mechanism that hemimastication result in masticatory muscles dysfunction.

Adenosine Triphosphate ; Calcium ; Humans ; Mastication ; Masticatory Muscles

Objective To summarize the clinical experience in the treatment of allogeneic lung transplantation with ABO-different donor. Methods Data of three cases of lung transplantation carried out in Tianjin First Central Hospital from August to September 2015 were retrospectively analysed. ABO blood groups were different but compatible in three donors who were with brain death, and their panel reactive antibody (PRA) and lymphocyte poison cross matching test were negative. The surgical approaches were left single-lung transplantation and sequential bilateral single-lung transplantation. After the surgery, measures for pneumonedema control, immuno suppression (mycophenolate mofetil + tacrolimus +glucocorticoids) and anti-infection (imipenem and cilastatin sodium+ micafungin sodium+ganciclovir) were carried out. Results The operation wsa completed successfully in all 3 patients, and the operative time was 5-6 hours. The cold ischemia time was less than 4 hours. The blood loss during the operation was 800-1000 mL. The trachea cannula extubation was pulled out within 24 h, thoracic drainage tube was pulled out within 72 h. All the patients were moved into general ward in 5-8 days. Patients discharged from hospital in 5 weeks after operation. Pneumonia infection occurred in 2 cases on the 6 th day after operation, and antibiotic treatment was upgraded and infection was cured after 3 weeks. All patients were followed up for 21-22 months, and 3 patients survived without serious complications such as graft rejection. Conclusion Comprehensive and effective surgical techniques, reasonable choice of donor lung and preservation method, active anti-infection strategy and triple immunosuppressive program can improve the survival rate after transplantation.

Objective To summarize the value of extracorporeal membrane oxygenation (ECMO) in right ventricular failure after heart transplantation. Methods Data of 31 cases with orthotopic heart transplantations from January 2016 to January 2018, in Tianjin First Central Hospital were retrospectively analyzed. Three patients received ECMO support because of right ventricular failure after operation.There were two males and one female in these three patients.Their ages were 52,38 and 67 years old.ECMO was performed in the heart transplantation(2 patients)and eight hours after the surgery. ECMO was established in these patients via femoral artery and femoral vein,V-A model.The mean blood flow was about 3.0 L/min.Continuous ventilator supports,low temperature sedation,anti-infection and nutrition support therapy were applied in the ECMO procedure.Results ECMO was weaned off successfully in all three patients.The time for ECMO was(144-177) h. All three patients were treated with continuous renal replacement therapy (CRRT). One patient had renal failure, the transition was given to regular dialysis after CRRT treatment, and the regular dialysis treatment after discharged from hospital.The ventilator time was(168.6±24.6)h in the three patients.The duration of staying in the intensive care unit was (31.8 ± 12.5) d. All three patients were discharged from the hospital successfully, and their cardiac function was normal. Conclusion ECMO can be used to treat right heart failure after heart transplantation,and the clinical effect is satisfactory.

Objective To evaluate the clinical efficacy and reliability of the minimally invasive treatment of patent ductus arteriosus (PDA) via the second intercostal incision on the left margin of sternum. Methods Clinical data of 31 infantile children undergoing ligation of PDA in Tianjin First Center Hospital from January 2014 to November 2017 were collected. All cases were performed operation through the second intercostal incision on the left margin of sternum. The operative process of this operation was summarized, and its clinical outcome was analyzed. Results The operation went smoothly,the length of the incision was(2.5±1.0)cm,the operation time was(1.5±0.2)h,the intraoperative bleeding was less than 5 mL,and the average length of hospital stay was(15.1±4.2)d.There were no complications such as death and massive hemorrhage in the perioperative period.The thoracic drainage tube was not needed after the operation.During the follow-up from 1 month to 4 years, catheter recanalization and aneurysm formation were undetected. Conclusion The treatment of PDA with the second intercostal incision on the left margin of sternum is safe and reliable.It has fewer complications and better long-term effect.