Objective:To compare the efficacy and safety differences between direct mechanical thrombectomy (abbreviated as direct thrombectomy) and bridging therapy in patients with acute anterior circulation large vessel occlusion and atrial fibrillation.Methods:A retrospective collection of data was conducted for hospitalized patients who underwent mechanical thrombectomy due to acute anterior circulation large vessel occlusion with atrial fibrillation at the First Affiliated Hospital of Soochow University and Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine from January 1, 2018 to December 31, 2022. Patients were divided into direct thrombectomy and bridging therapy groups based on whether intravenous thrombolysis was used, and the clinical outcomes and safety indicators of the two groups were compared. The primary clinical outcomes included the modified Rankin Scale (mRS) score at 90 days and the proportion of patients with neurological independence at 90 days (the proportion of patients with mRS scores of 0-2). Safety indicators included 90-day mortality rate, intracranial hemorrhage rate, symptomatic intracranial hemorrhage [deterioration of neurological function and an increase of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score] rate, and pneumonia incidence. Using the 90-day prognosis as a dependent variable, a binary Logistic regression analysis was conducted to investigate the factors influencing poor prognosis in patients at 90 days.Results:Among the 534 screened patients, 125 were included in the study, with 74 in the direct thrombectomy group and 51 in the bridging therapy group. The difference in the mRS scores at 90 days between the direct thrombectomy group and the bridging therapy group was not statistically significant [2 (0, 3) vs 3 (1, 3), Z=-1.444, P=0.149]. The difference in the proportion of patients with independent neurological function at 90 days [66.2% (49/74) vs 47.1% (24/51), χ2=4.561, P=0.033] was statistically significant between the 2 groups. The 90-day mortality rate [5.4% (4/74) vs 9.8% (5/51), χ 2=0.936, P=0.483], the intracranial hemorrhage rate [17.6% (13/74) vs 29.4% (15/51), χ 2=2.437, P=0.119], the symptomatic intracranial hemorrhage rate [12.2% (9/74) vs 23.5% (12/51), χ 2=2.791, P=0.095], and the pneumonia incidence [59.5% (44/74) vs 56.9% (29/51), χ 2=0.084, P=0.772] between the 2 groups showed no statistically significant differences (all P>0.05). The time from admission to puncture was 97 (74, 122) min and 150 (127, 168) min for the direct thrombectomy and bridging therapy groups, respectively, with a statistically significant difference ( Z=-5.846, P<0.001). Binary Logistic regression analysis showed that venous thrombolysis (adjusted OR=3.004, 95% CI 1.057-8.539, P=0.039), NIHSS score at onset (adjusted OR=1.096, 95% CI 1.009-1.191, P=0.030), and pneumonia (adjusted OR=12.814, 95% CI 3.775-43.499, P<0.001) were associated with poor prognosis at 90 days. Conclusion:For patients with acute anterior circulation large vessel occlusion and atrial fibrillation, direct thrombectomy can increase the proportion of neurological independence at 90 days compared to bridging therapy, with no statistically significant differences in safety indicators, which may be related to the shorter time from admission to puncture in the direct thrombectomy group.

Objective:To compare the efficacy and safety differences between direct mechanical thrombectomy (abbreviated as direct thrombectomy) and bridging therapy in patients with acute anterior circulation large vessel occlusion and atrial fibrillation.Methods:A retrospective collection of data was conducted for hospitalized patients who underwent mechanical thrombectomy due to acute anterior circulation large vessel occlusion with atrial fibrillation at the First Affiliated Hospital of Soochow University and Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine from January 1, 2018 to December 31, 2022. Patients were divided into direct thrombectomy and bridging therapy groups based on whether intravenous thrombolysis was used, and the clinical outcomes and safety indicators of the two groups were compared. The primary clinical outcomes included the modified Rankin Scale (mRS) score at 90 days and the proportion of patients with neurological independence at 90 days (the proportion of patients with mRS scores of 0-2). Safety indicators included 90-day mortality rate, intracranial hemorrhage rate, symptomatic intracranial hemorrhage [deterioration of neurological function and an increase of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score] rate, and pneumonia incidence. Using the 90-day prognosis as a dependent variable, a binary Logistic regression analysis was conducted to investigate the factors influencing poor prognosis in patients at 90 days.Results:Among the 534 screened patients, 125 were included in the study, with 74 in the direct thrombectomy group and 51 in the bridging therapy group. The difference in the mRS scores at 90 days between the direct thrombectomy group and the bridging therapy group was not statistically significant [2 (0, 3) vs 3 (1, 3), Z=-1.444, P=0.149]. The difference in the proportion of patients with independent neurological function at 90 days [66.2% (49/74) vs 47.1% (24/51), χ2=4.561, P=0.033] was statistically significant between the 2 groups. The 90-day mortality rate [5.4% (4/74) vs 9.8% (5/51), χ 2=0.936, P=0.483], the intracranial hemorrhage rate [17.6% (13/74) vs 29.4% (15/51), χ 2=2.437, P=0.119], the symptomatic intracranial hemorrhage rate [12.2% (9/74) vs 23.5% (12/51), χ 2=2.791, P=0.095], and the pneumonia incidence [59.5% (44/74) vs 56.9% (29/51), χ 2=0.084, P=0.772] between the 2 groups showed no statistically significant differences (all P>0.05). The time from admission to puncture was 97 (74, 122) min and 150 (127, 168) min for the direct thrombectomy and bridging therapy groups, respectively, with a statistically significant difference ( Z=-5.846, P<0.001). Binary Logistic regression analysis showed that venous thrombolysis (adjusted OR=3.004, 95% CI 1.057-8.539, P=0.039), NIHSS score at onset (adjusted OR=1.096, 95% CI 1.009-1.191, P=0.030), and pneumonia (adjusted OR=12.814, 95% CI 3.775-43.499, P<0.001) were associated with poor prognosis at 90 days. Conclusion:For patients with acute anterior circulation large vessel occlusion and atrial fibrillation, direct thrombectomy can increase the proportion of neurological independence at 90 days compared to bridging therapy, with no statistically significant differences in safety indicators, which may be related to the shorter time from admission to puncture in the direct thrombectomy group.

Objective:To investigate the relationship of Castleman disease (CD) and connective tissue disease (CTD).Methods:Clinical records and laboratory data of 11 patientsdiagnosed with CD and CTD were collected and retrospectively analyzed. All patients were diagnosed at Peking Union Medical College Hospital.Results:① The proportion of CD associated with or mimicking CTD was 5.67% (11/194) in all CD patients during the same period. The average age of these cases at the diagnosis was (51±17) years and the ratio of male to female was 6∶5. ② Lymphadenopathy (10/11), fever (8/11), serosal effusion (6/11), arthralgia (5/11), alopecia (2/11), Raynaud phenomenon (1/11) and photosensitivity (1/11) were the common clinical manifest- ations that could mimic CTD. ③ Elevated ESR (11/11), hypoalbuminemia (11/11), elevated CRP (10/11), elevated IgG (7/11), proteinuria (5/11), hematuria (5/11) and positive ANA(5/11) were commonly found in the patients' laboratory tests. ④ CD was inclined to mimic systemic lupus erythematosus(SLE)(5/11), IgG4-related disease(IgG4-RD)(2/11) and adult onset Still's disease(AOSD)(2/11), as well as 2 cases were associated with Sj?gren's Syndrome(SS)(2/11). ⑤All cases were ultimately diagnosed as multicentric CD, the pathologic subtypes were plasma cell variant (10/11) and mixed(1/11) respectively.Conclusion:CD maybe overlapped with or mimic a variety of clinical manifestations, such as fever, serosal effusion, arthralgia and proteinuria which could mimic CTD. Early biopsy is helpful for the diagnosis and to avoid misdiagnosis and mistreatment.

Objective:To explore efficacy and safety of endovascular therapy combined with hyperbaric oxygen (HBO) intervention in acute anterior circulation macrovascular occlusion stroke.Methods:A total of 150 patients with acute anterior circulation macrovascular occlusive stroke admitted in No.902 Hospital of the CPLA Joint Logistic Support Force were selected and randomly divided into endovascular treatment group and combined treatment group (endovascular+ HBO). Endovascular therapy was adopted in the treatment of all patients. Modified thrombolytic flow grading (mTICI) was used to evaluate vascular recanalization after operation, and the incidences of complications of hemorrhage transformation and vascular re-occlusion were recorded. National institutes of health stroke scale (NIHSS) was used to evaluate the neurological functions on admission, at 24 hours after the operation, and one course after HBO therapy. The prognosis was evaluated by observing the changes of blood homocysteine (HCY) and high-sensitivity C-reactive protein (hs-CRP) levels before and after treatment. The patients had been followed up by the modified Rankin Scale (mRS) for 90 days. At the same time, 75 patients with acute anterior circulation macrovascular occlusive stroke without taking endovascular treatment were selected as the control group.Results:Among 150 patients, 126 cases had a grade of mTICI≥2b, while 24 cases had a grade of mTICI<2b. Postoperative vascular re-occlusion occurred in 3 cases, and symptomatic intracranial hematoma occurred in 6 cases. The NIHSS score at 24 hours after the operation was significantly lower than that on admission, and the NIHSS score was further improved after HBO treatment. Ninety days after the operation, mRS showed 98 cases of good prognoses, while 52 cases of poor prognoses. The levels of HCY and hs-CRP were significantly lower than those before the treatment.Conclusion:Endovascular therapy for acute anterior circulation macrovascular occlusive stroke is safe and effective. Postoperative HBO therapy can significantly improve the prognosis and the quality of life of patients.

Objective:To explore efficacy and safety of endovascular therapy combined with hyperbaric oxygen (HBO) intervention in acute anterior circulation macrovascular occlusion stroke.Methods:A total of 150 patients with acute anterior circulation macrovascular occlusive stroke admitted in No.902 Hospital of the CPLA Joint Logistic Support Force were selected and randomly divided into endovascular treatment group and combined treatment group (endovascular+ HBO). Endovascular therapy was adopted in the treatment of all patients. Modified thrombolytic flow grading (mTICI) was used to evaluate vascular recanalization after operation, and the incidences of complications of hemorrhage transformation and vascular re-occlusion were recorded. National institutes of health stroke scale (NIHSS) was used to evaluate the neurological functions on admission, at 24 hours after the operation, and one course after HBO therapy. The prognosis was evaluated by observing the changes of blood homocysteine (HCY) and high-sensitivity C-reactive protein (hs-CRP) levels before and after treatment. The patients had been followed up by the modified Rankin Scale (mRS) for 90 days. At the same time, 75 patients with acute anterior circulation macrovascular occlusive stroke without taking endovascular treatment were selected as the control group.Results:Among 150 patients, 126 cases had a grade of mTICI≥2b, while 24 cases had a grade of mTICI<2b. Postoperative vascular re-occlusion occurred in 3 cases, and symptomatic intracranial hematoma occurred in 6 cases. The NIHSS score at 24 hours after the operation was significantly lower than that on admission, and the NIHSS score was further improved after HBO treatment. Ninety days after the operation, mRS showed 98 cases of good prognoses, while 52 cases of poor prognoses. The levels of HCY and hs-CRP were significantly lower than those before the treatment.Conclusion:Endovascular therapy for acute anterior circulation macrovascular occlusive stroke is safe and effective. Postoperative HBO therapy can significantly improve the prognosis and the quality of life of patients.

Background Diabetic retinopathy (DR) is a progressive vision-threatening complication of diabetes mellitus (DM),but its pathogenic mechanism is still unclear.Researches showed that growth arrest-specific gene product 6 (Gas6) /TAM system participates in pathogenesis and development of DR,and stromal-derived factors (SDF) vary in 2-type DM patients.However,whether Gas6/TAM and SDF-1 are associated with DR is below understood.Objective This study was to determine the relationship between the staging of DR and the levels of serum Gas6,SDF-1α and SDF-1β in DM patients.Methods A prospective cohord study was designed in this study.Ninety 2-type DM patients were included in the 3rd Affiliated Hospital of Southern Medical University Hospital from January to August in 2013.The patients were grouped into the non-diabetic retinopathy (NDR) group,background DR group (BDR) and proliferative DR (PDR) group,with 30 for each group.Thirty normal volunteers were enrolled in the same hospital and same period.The periphery blood 2 ml was collected from all the subjects under the consent inform.The levels of serum Gas6,SDF-1α and SDF-1β were assayed by ELISA,and leukocytes,neutrophils,plasma triglycerides (TG),total cholesterol (CHOL),high density lipoprotein cholesterol (H DL-C) and low density lipoprotein cholesterol (LDL-C) levels were detected and compared among the 4 groups.The correlations of serum Gas6,SDF-1 α and SDF-1 β changes with blood inflammatory cells and blood lipid were analyzed.Results The plasma CHOL concentrations were 4.93(4.14,5.44),5.02(4.35,5.69),4.54(3.85,5.93) and 5.99(5.11,6.89)mmol/L in the normal control group,NDR group,BDR group and PDR group,respectively,and the blood CHOL concentrations were significantly higher in the PDR group than those of the normal control group,NDR group,BDR group (P =0.002,P =0.007,P =0.006).White blood cell counts in the normal control group,BDR group were higher than those of the PDR group (P =0.034,P =0.015),neutrophil counts in the BDR group were higher than those of the PDR group (P =0.024),HDL-C in the NDR group was higher than that in the PDR group (P =0.032).LDL-C in the PDR group was higher than that in the normal control group.Compared with the normal control group,serum Gas6 levels were significantly lower in the NDR group and BDR group (P =0.048,P =0.006),and the serum Gas6 level showed an insignificant increase in the PDR group in comparison with BDR group (P =0.297).Serum SDF-1α levels in the PDR group was significantly higher than that in the BDR group (P =0.033) ;serum SDF-1β levels in the PDR group,BDR group were significantly higher than that in the NDR group (P =0.011,P =0.008) and normal control group (P =0.030,P =0.002).Weaker positive correlation was observed between the serum Gas6 and CHOL,TG,LDL-C levels (r=0.285,r=0.200,r=0.241,all at P＜0.05),between SDF-1α and SDF-1β (r=0.190,P＜0.05) as well as between SDF-1β and white blood cell (r=0.183,P＜0.05).Serum Gas6 served as dependent variable,while white blood cell,neutrophil,CHOL,TG,HDL-C,LDL-C,SDF-1α,SDF-1β served as independent variables,multiple stepwise regression analysis showed Gas6 =170.791 + 5.283CHOL (F =5.021,P =0.027).Conclusions Serum Gas6,SDF-1α and SDF-1β probably participate in the development of DR in 2-type diabetic patients.Gas6,SDF-1 α,SDF-1 β may play roles by affecting blood glucose level,angiogenesis,inflammatory cells and blood lipid metabolism.

Objective To detect the levels of AKAP12 methylation by methylation‐specific high‐resolution melting curve(MS‐HRM ) in peripheral blood in patients with colorectal cancer and investigate its clinical significance .Methods We used MS‐HRM technology to detect the levels of AKAP12 methylation in peripheral blood in 60 lung cancer patients ,and analyzed the relationship between the levels of AKAP12 methylation and pathological parameters of lung cancer patients .Results 34(56 .7% ) of the 60 lung cancer patients were found to be methylated at the AKAP12 promoter region by MS‐HRM ,the methylation levels of 18 cases ranged between 1% -20% ,14 cases ranged between 20% -60% ,2 cases ranged between 60% -100% .There was no significant differences between the levels of AKAP12 methylation and lung cancer patients′age and gender(P>0 .05) .However ,it was signifi‐cantly higher in the patients with high pathological stage and differentiation degree (P<0 .05) .Conclusion AKAP12 promoter re‐gion methylation was related to tumor progression and malignant degree .

OBJECTIVE: To discuss the feasibility of endoscopic frontal sinus surgery in the nasal septum median path. METHOD: (1) Sixty adult cadaveric heads fixed with formalin were CT scanned,and were three dimensional reconstruction. (2) Thirty adult cadaveric heads were sawn along the sagittal line close to the side of the nasal septum, then the important anatomic marks were observed and measured. (3) Combined with CT and anatomical data, thirty adult cadaveric heads were operated in different degree, and the damage of nasal septum and fila olfactoria were detected in the same time. RESULT: (1) The roots of middle nasal concha were simulated in the endoscopic frontal sinus surgery. The operation time, operative procedures, markers foundation, endoscopic back of posterior border of frontal sinus foundation and attached to the symphysis with cribriform plate and the top of ethmoidal sinus were recorded. (2) The intersection point formed by the level of middle nasal concha and the vertical of middle nasal concha corresponded with the nasal septum was called the M point. The distance from the M point to the horizon of the nasal bone was (20.07 +/- 6.21) mm, the distance from the M point to the first fila olfactoria was (24.38 +/- 7.68) mm, the distance from the first fila olfactoria to the posterior edge of frontal sinus was (9.57 +/- 2.73) mm, the distance from the root of the middle nasal concha to posterior edge of frontal sinus was (5.38 +/- 1.23) mm, the anteroposterior diameter of frontal sinus fundus was (7.62 +/- 2.45) mm, the transverse diameter of frontal sinus fundus was (9.41 +/- 3.37) mm, the seesaw diameter of frontal sinus partition was (16.97 +/- 3.23) mm, the anteroposterior diameter of frontal sinus partition was (12.34 +/- 2.23) mm. (3) The operation time through the nasal septum path was 105 minutes which combined with CT and anatomical measurements. 0 degrees endoscopy could be used to observe the frontal part of the lateral, posterior and top wall, while nasal septum remove should be finished with 30 degree endoscopy. The bottom of frontal sinus can be exposed and removed with 0 degree endoscopy. 3 cases of cadaveric frontal sinus lateral wall can not be observed with 70 degree endoscopy. 30 cases of cadaveric frontal sinus,some of the top and the lateral wall, anterior and posterior wall could be observed with 70 degree endoscopy, nasal septum damage range was about 2.23 cm x 2.59 cm, and no fila olfactoria damage was found. CONCLUSION Endoscopic frontal sinus surgery in the nasal septum median path is a good way to find frontal sinus.
Endoscopy ; methods ; Feasibility Studies ; Frontal Sinus ; diagnostic imaging ; surgery ; Humans ; Nasal Bone ; diagnostic imaging ; surgery ; Nasal Septum ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

Objective To evaluate the angiographic findings and the therapeutic effect of thrombolysis in AMI (acute myocardial infarction) patients. Method A retrospective study were carried out in consecutive eighty-four inpatients with AMI treated with intravenous thrombolysis and coronary angiography was taken within a week after illness onset from January 2000 to August 2007. The patients were divided into successful recanalization group and non-recanalization group. Single factor χ2 test and multi-factor logistic regression analysis were applied to observe the relationship among the angiographic features of IRA (infarct-related artery including the number of stnosis, the location of stenosis, the severity of stenosis and the morphological changes) and treatment effect of intravenous urokinase thrombolysis. Results (1) Single factor χ2 test showed that location and the extent of lesion of IRA were eligible to enter the logistic regression formula (P ＜ 0.05),whereas the number of lesions and the severity of IRA's stenosis were not eligible to enter the logistic regression formula (P ＞ 0. 05). (2) Multi-factor logistic regression analysis showed that the extent of lesion of IRA was the only factor that had a negative impact on the therapeutic effect of intravenous thrombolysis.Conclusions The study shows that the extent of lesion of IRA is the only factor that has a negative impact on the therapeutic effect of intravenous thrombolysis; The number, the location of lesion and the severity of stenosis of IRA have no impact on the therapeutic effect of intravenous thrombolysis in AMI.

The combined use of chemometrics and chemiluminescence (CL) measurements,with the aid of the stoppedflow mixing technique,developed a simple time-resolved CL method for the simultaneous determination of captopril (CPL) and hydrochlorothiazide (HCT).The stopped-flow technique in a continuous-flow system was employed in this work in order to emphasize the kinetic differences between the two analytes in cerium (Ⅳ)-rhodamine 6G CL system.After the flow was stopped,an initial rise of CL signal was observed for HCT standards,while a direct decay of CL signal was obtained for CPL standards.The mixed CL signal was monitored and recorded on the whole process of continuousflow/stopped-flow,and the obtained data were processed by the chemometric approach of artificial neural network.The relative prediction error (RPE) of CPL and HCT was 5.9％ and 8.7％,respectively.The recoveries of CPL and HCT in tablets were found to fall in the range between 95％ and 106％.The proposed method was successfully applied to the simultaneous determination of CPL and HCT in a compound pharmaceutical formulation.