Objective To study the different effects on unilateral middle cerebral artery infarction with standard large trauma craniotomy and frontotemporal craniectomy and decompression treatment.Methods The clinical data of 56 patients with unilateral middle cerebral artery infarction were retrospectively analyzed.They were divided into the two groups according to the different operation methods,and compared the incidence of postoperative complications and GCS score after 1 week,GOS score after 1 month,and ADL score after 6 months and so on.Results The differences were significant between the two groups in incidence of postoperative complications [ incidence of rebleeding after the operation(A group 5 cases,B group 4 cases),showing of brain pools(A group 23 cases,B group 14 cases),lung infection(A group 7 cases,B group 13 cases),gastrointestinal bleeding(A group 8 cases,B group 17 cases),χ2 =0.579,4.703,8.606,7.081] and postoperative GCS score after a week[12 -15points(A group 5 cases,B group 2 cases),9-11points(A group 15 cases,B group 10 cases),5-8points(A group 6 cases,B group 8 cases),3-4points(A group 2 cases,B group 4 cases),death(A group 1 case,B group 3 cases),W value was 599.500,P=0.028] (all P<0.05).There was significant difference in postoperative GOS score and rate of brain tissue bulging after a month [ advantages ( A group 7 cases, B group 4 cases ) , good ( A group 15 cases, B group 8 cases),middle(A group 3 cases,B group 6 cases),poor(A group 2 cases,B group 4 cases),death(A group 1 case,B group 2 cases),encephalocele(A group 9 cases,B group 19 cases),W value was 492.000,P=0.007](all P<0.05).There was no difference in postoperative ADL score half of a year(P>0.05).Conclusion Standard large trauma craniotomy has features as decompression full,low early complication rate,and can improve the short-term efficacy of unilateral middle cerebral artery infarction in patients,and promote recovery.

Objective:To observe the curative effect of stereotactic subtentorial approach for brainstem puncture and drainage on brain stem hemorrhage in elderly patients.Methods:The clinical data of elderly patients with brain stem hemorrhage admitted to the Department of Neurosurgery, Shangqiu First People 's Hospital from April 2018 to April 2022 were retrospectively analyzed.According to the inclusion and exclusion criteria, a total of 65 elderly patients with brainstem hemorrhage who were treated with stereotactic subtentorial approach for brain stem puncture and drainage, and had complete follow-up data within 90 days after operation were selected.The patient's data were reviewed.The operation time, hematoma clearance rate on the first day after operation, the drainage tube extraction of hematoma cavity, and the postoperative complications were recorded.The follow-up results at 30 days and 90 days after the operation were also recorded.The 30-day Glasgow outcome scale(GOS)was used to evaluate the short-term clinical outcomes of surviving patients, while the modified Rankin score was used to evaluate the neurological function recovery of surviving patients at 90 days.Results:The operation time of the 65 patients was 1.1-2.8 h, with an average of(1.9±0.4)h.On the first day after operation, CT scan showed that the hematoma clearance rate was(84.6±13.6)%.The drainage tube in hematoma cavity was removed within 3-5 days, and there was no puncture-related intracerebral hemorrhage or drainage tube-related intracranial infection after operation.During 30 days of follow-up, 9 patients died and 56 patients survived, with a survival rate of 86.2%.Among the surviving patients, 5 were temporarily in vegetative state and 51 were awake, with varoius degrees of disability.The preoperative hematoma volume of the surviving patients was significantly less than that of the dead patients, and the preoperative GCS score was significantly lower than that of the dead patients( Z=2.386, 2.009, P=0.017, 0.045). After 90 days of follow-up, 3 patients died and 53 survived, with a survival rate of 81.54%.Among the surviving patients, the neurological function of 22 patients recovered well, and the effective rate of clinical treatment was 41.51%. Conclusions:Stereotactic subtentorial approach for brain stem puncture and drainage is an effective and relatively safe surgical method for the treatment of brain stem hemorrhage in elderly patients.

Objective:To analyze the correlation of serum homocysteine(Hcy)levels with hematoma absorption and cognitive function in elderly patients with cerebral hemorrhage.Methods:Clinical data of 80 elderly patients with cerebral hemorrhage admitted to our hospital from January 2017 to July 2019 were retrospectively analyzed.According to serum levels of Hcy(normal range: <15 μmol/L), 21 patients with serum Hcy<15 μmol/L were included in Group A, and 59 patients with Hcy≥15 μmol/L were included in Group B. General data(gender, age, hypertension, diabetes, bleeding part, bleeding volume, etc.), hematoma absorption and cognitive function were recorded and compared between the two groups.The correlation of serum Hcy levels with hematoma absorption and cognitive function in elderly patients with cerebral hemorrhage was analyzed by using Spearman correlation analysis.Results:There was no statistical difference in gender, age, hypertension, diabetes, bleeding location and bleeding volume between the two groups.The speed of hematoma absorption and scores of Montreal Cognitive Assessment(MoCA)were higher in Group A than in Group B[(0.4±0.1)ml/d vs.(0.3±0.1)ml/d, (19.6±4.6)points vs.(16.3±3.3)points, t=3.935 and 3.532, both P=0.000]. Spearman correlation analysis showed that serum Hcy level was negatively correlated with hematoma absorption and cognitive function in elderly patients with cerebral hemorrhage( r=-0.372 and-0.311, P=0.000 and 0.005), indicating that hematoma absorption and cognitive function were worse with the higher serum Hcy levels in elderly patients with cerebral hemorrhage. Conclusions:Serum Hcy levels change in elderly patients with cerebral hemorrhage.As serum Hcy levels increase, the risk for adverse events such as slow hematoma absorption and unsatisfactory improvement in cognitive function in patients increases accordingly.Serum Hcy levels play an important role in the occurrence and development of diseases in elderly patients with cerebral hemorrhage and can be used to evaluate the condition and prognosis of patients with cerebral hemorrhage.

OBJECTIVETacrolimus (FK506) is an immunosuppressive drug, which is widely used to prevent rejection of transplanted organs. However, chronic administration of FK506 leads to hypertension in solid organ transplantation patients, and its molecular mechanisms are much more complicated. In this review, we will discuss the above-mentioned molecular mechanisms of FK506-induced hypertension in solid organ transplantation subjects.

DATA SOURCESThe data analyzed in this review were mainly from relevant articles without restriction on the publication date reported in PubMed. The terms "FK506" or "tacrolimus" and "hypertension" were used for the literature search.

STUDY SELECTIONOriginal articles with no limitation of research design and critical reviews containing data relevant to FK506-induced hypertension and its molecular mechanisms were retrieved, reviewed and analyzed.

RESULTSThere are several molecular mechanisms attributed to FK506-induced hypertension in solid organ transplantation subjects. First, FK506 binds FK506 binding protein 12 and its related isoform 12.6 (FKBP12/12.6) and removes them from intracellular ryanodine receptors that induce a calcium ion leakage from the endoplasmic/sarcoplasmic reticulum. The conventional protein kinase C beta II (cPKCβII)-mediated phosphorylation of endothelial nitric oxide (NO) synthase at Thr495, which reduces the production of NO, was activated by calcium ion leakage. Second, transforming growth factor receptor/SMAD2/3 signaling activation plays an important role in Treg/Th17 cell imbalance in T cells which toget converge to cause inflammation, endothelial dysfunction, and hypertension following tacrolimus treatment. Third, the activation of with-no-K(Lys) kinases/STE20/SPS1-related proline/alanine-rich kinase/thiazide-sensitive sodium chloride co-transporter (WNKs/SPAK/NCC) pathway has a central role in tacrolimus-induced hypertension. Finally, the enhanced activity of renal renin-angiotensin-aldosterone system seems to play a crucial role in the pathophysiology of FK506-induced hypertension.

CONCLUSIONFK506 plays a predominant role in the pathophysiology of hypertension in solid organ transplantation subjects.

Humans ; Hypertension ; chemically induced ; Immunosuppressive Agents ; adverse effects ; therapeutic use ; Organ Transplantation ; adverse effects ; Tacrolimus ; adverse effects ; therapeutic use

OBJECTIVE: To investigate the associations between chronic kidney disease (CKD) and body mass index (BMI), waist circumference(WC), waist-to-height ratio (WheiR) in Chinese adults.
 METHODS: A total of 26 655 participants, who voluntarily attended annual health examination at the Health Management Center in the Third Xiangya Hospital of Central South University from June 2013 to February 2014, were enrolled for this study. Logistic regression and receiver operating characteristic (ROC) curve analysis were performed.
 RESULTS: The prevalence rate of CKD was 9.6% and 3.1% in male and female subjects, respectively. Multivariate logistic regression analysis showed that BMI, WC and WheiR were independent risk factors for CKD in diabetic male and hypertensive male subjects (P<0.01). However, no association between these obesity indices and CKD was found in women after multivariate adjustment. In diabetic male subjects, when BMI≥28.7 kg/m(2), WC=90.7 cm and WheiR=0.56, the sensitivity and specificity prediction for CKD was 24.8%, 58.5%, 45.5% and 83.3%, 54.4%, 69.6%, respectively. In hypertensive male subjects, when the optimum cut-off points for BMI, WC and WheiR were ≥
27.0 kg/m(2), 91.2 cm and 0.54, the sensibility prediction for CKD were 41.0%, 47.0% and 50.1%, respectively, while the specificity prediction were 68.0%, 63.0% and 61.4%, respectively. The area under the ROC curve of BMI, WC, WheiR for CKD prediction were 0.56, 0.57, 0.59 in diabetic male subjects and 0.54, 0.56, 0.57 in hypertensive male subjects, respectively.
 CONCLUSION BMI, WC and WheiR are associated with the increased risk for CKD in diabetic or hypertensive male subjects. However, the value for these obesity indices is limited in screening CKD.
Adult ; Asian Continental Ancestry Group ; Body Mass Index ; Cross-Sectional Studies ; Diabetes Mellitus ; epidemiology ; Female ; Humans ; Hypertension ; epidemiology ; Logistic Models ; Male ; Multivariate Analysis ; Obesity ; epidemiology ; Prevalence ; ROC Curve ; Renal Insufficiency, Chronic ; diagnosis ; epidemiology ; Risk Factors ; Waist Circumference ; Waist-Height Ratio