Background: and Purpose Intravenous tenecteplase (TNK) efficacy has not been well demonstrated in acute ischemic stroke (AIS) beyond 4.5 hours after onset. This study aimed to determine the effect of intravenous TNK for AIS within 4.5 to 24 hours of onset. Methods: In this pilot trial, eligible AIS patients with diffusion-weighted imaging (DWI)-fluid attenuated inversion recovery (FLAIR) mismatch were randomly allocated to intravenous TNK (0.25 mg/kg) or standard care within 4.5–24 hours of onset. The primary endpoint was excellent functional outcome at 90 days (modified Rankin Scale [mRS] score of 0–1). The primary safety endpoint was symptomatic intracranial hemorrhage (sICH). Results: Of the randomly assigned 80 patients, the primary endpoint occurred in 52.5% (21/40) of TNK group and 50.0% (20/40) of control group, with no significant difference (unadjusted odds ratio, 1.11; 95% confidence interval 0.46–2.66; P=0.82). More early neurological improvement occurred in TNK group than in control group (11 vs. 3, P=0.03), but no significant differences were found in other secondary endpoints, such as mRS 0–2 at 90 days, shift analysis of mRS at 90 days, and change in National Institutes of Health Stroke Scale score at 24 hours and 7 days. There were no cases of sICH in this trial; however, asymptomatic intracranial hemorrhage occurred in 3 of the 40 patients (7.5%) in the TNK group. Conclusion This phase 2, randomized, multicenter study suggests that intravenous TNK within 4.5–24 hours of onset may be safe and feasible in AIS patients with a DWI-FLAIR mismatch.

Aged ; Cognitive Dysfunction/epidemiology* ; Cross-Sectional Studies ; Geriatric Assessment ; Humans ; Independent Living ; Sarcopenia/epidemiology*

Objective To explore the method of WeChat medication education for patients used by pharmacists,and to investigate the effect of WeChat medication education at Peking university third hospital.Methods Totally 30 patients who used warfarin at Peking university third hospital were enrolled.A series of subscriptions concerning warfarin medication education were sent to patients and/or their caregivers by WeChat regularly.The medication knowledge score after/before the intervention were assessed.Results The score of patients' warfarin medication knowledge before intervention was (14.20 ± 1.97) points,and after that the score was (16.63 ± 1.74) points,showing an improvenent with significance (P ＜ 0.001).Questions about adverse events of warfarin were most likely to be answered by mistake and the score of relevant questions was only (0.97 ± 0.80) points and (1.07 ± 0.81) points,respectively (P ＞ 0.05) before and after intervention.Conclusion It is of great significance for pharmacists to provide warfarin medication education.It is proved effective to improve patients' recognition of warfarin medication by means of WeChat subscriptions.

OBJECTIVE: To explore the distribution of inflammatory cells and positive expression of P-se- lectin glycoprotein ligand-1 (PSGL-1) in infant brainstem tissue from hand-foot-mouth disease related fatal brainstem encephalitis. METHODS: Twenty brainstem samples from infants suffered from brainstem en- cephalitis were collected as the experimental group. Ten brainstem samples from infants died of non- brain diseases and injuries were collected as the control group. The distribution of inflammatory cells and the expression of PSGL-1 in the two groups were examined by immunohistochemical method. The characteristics of the positive cells were observed. RESULTS: In brainstem tissue of the experimental group, there were sleeve infiltrations of inflammatory cells around the vessels and in the glial nodule. Microglia was the most and following was neutrophils around the vessels and in the glial nodule. There was a significant statistical difference among microglias, neutrophils and lymphocytes (P < 0.05). There was no sleeve infiltration in the control group. PSGL-1 protein was expressed widely in inflammatory cells in the experimental group, especially in the inflammatory cells around the vessels and in the glial nodule. But PSGL-1 positive staining could be observed significantly less in the control group comparing with the experimental group (P < 0.05). CONCLUSION Microglia is the main type of inflammatory cells involved in the progress of the fatal disease. Moreover, PSGL-1 could participate in the pathogenesis of hand-foot-mouth disease related fatal brainstem encephalitis.
Brain Stem/pathology* ; Encephalitis/pathology* ; Hand, Foot and Mouth Disease/pathology* ; Humans ; Infant ; Membrane Glycoproteins/metabolism* ; Microglia/pathology* ; Neutrophils/pathology*

Objective To discuss the microsurgical resection of intracranial cystic tumors.Methods From August 2003 to August 2010, 47 patients who had been diagnosed by imaging with intracranial cystic tumor received microsurgical resection. The tumors were confirmed by pathological examination postoperation.There were 22 cases of cystic glioma,8 cases of cystic meningioma,3 cases of malignant cystic meningioma,4 cases of cystic ependymoma,4 cases of angioreticuloma and 6 cases of cystic metastatic tumor.When the skull was minimally opened according to the location of the tumor,the hydatid fluid was absorbed before separation and resection of the tumor with its capsule under endoscopy. Results Total resection was performed in 31 cases (65.96％) and sub-total resection in 16cases (34.04％).No operative death occurred.Neural dysfunction was observed not long postoperation in 6 cases (12.77％),including one case of trigeminal nerve injury,one case of abducent nerve injury,one case of facial nerve dysfunction,one case of glossopharyngeal nerve injury,2 cases of paralysis and 2cases of hydrocephalus.Forty-one patients were followed up for 0.5 to 6 years.Eight patients (17.02％)had recurrence and 2 died. Conclusion Microneurosurgery can improve the total resection rate of intracranial cystic tumors with minimal invasion to neural functions.

Objective To investigate the impact of cytochrome P450 (CYP) 2C19 681G>A polymorphism on long-term prognosis of clopidogrel-treated Chinese patients after percutaneous coronary intervention (PCI).Methods Between January 1, 2009 and August 31,2009, 267 patients with coronary heart disease who received PCI and treated with clopidogrel for 12 months were enrolled. CYP2C19*2 was detected by MALDI-TOF MS and patients were grouped into CYP2C19*1/*1(n=130) and CYP2C19*2 carriers group (n=137). Follow-up was 12 months. The primary endpoint was angina recurrence, urgent coronary revascularization, acute myocardial infarction, stent thrombosis, death and the combined end points. Results Baseline data were similar between two groups (P>0.05).Urgent coronary revascularization and the combined end points occurred more frequently in CYP2C19*2 carriers than in CYP2C19*1/*1 patients (7.3% vs. 1.5% and 8.0% vs. 2.3% respectively,all P<0.05). But incidence of angina recurrence, acute myocardial infarction, stent thrombosis and death was similar between two groups (all P>0.05).Hazard risk of 1 year cumulative survival of CYP2C19*2 carriers group was significantly higher than CYP2C19*1/*1 group after PCI (HR=3.59, 95%CI: 1.02-12.87, P<0.05). Conclusion CYP2C19 681G>A polymorphism is a determinant of prognosis in coronary heart disease patients receiving chronic clopidogrel treatment after PCI.

Objective To survey the risk factors of metabolic syndrome (MS) of military flying personnel so as to provide the basis of prevention and control measures.Methods Body mass index (BMI),triglyceride (TG),fasting plasma glucose (FPG) and blood pressure (BP) were measured for 682 flying personnel.Such diagnostic criteria as BMI≥ 25 kg/m2 (obesity),TG≥ 1.7 mmol/L (hypertriglyceridemia),BP≥ 140/90 mm Hg (hypertension),and FPG≥ 6.1 mmol/L (impaired fasting blood glucose,IFG) were chosen based on the criteria issued by China Diabetes Association in 2004.MS was diagnosed in case of the personnel exceeded above 3 or more criteria.Their health history was reviewed upon above mentioned parameters for comparison and analysis.Results The crude prevalence of MS was 6.45％ (44 out of 682 cases).The prevalence of MS was 0.00％,4.73％,18.99％ and 25.00％ respectively corresponding to the flying personnel aged over 20,30,40 and 50 years old.The prevalence of obesity,hyper triglyceride,hypertension,raised fasting blood glucose was 39.44 ％,22.29 ％,8.21％,and 1.61％ respectively.Among which,321 personnel were diagnosed as metabolic disorders based on one or more abnormal parameters.The total prevalence of abnormal metabolic index was 47.07％.Conclusions The prevalence of MS is so high in military flying personnel.Overweight,hyper triglyceride and aging have become the high risk factors to MS.It is necessary to take early intervention for preventing MS.

Objective To survey the risk factors of metabolic syndrome (MS) of military flying personnel so as to provide the basis of prevention and control measures.Methods Body mass index (BMI),triglyceride (TG),fasting plasma glucose (FPG) and blood pressure (BP) were measured for 682 flying personnel.Such diagnostic criteria as BMI≥ 25 kg/m2 (obesity),TG≥ 1.7 mmol/L (hypertriglyceridemia),BP≥ 140/90 mm Hg (hypertension),and FPG≥ 6.1 mmol/L (impaired fasting blood glucose,IFG) were chosen based on the criteria issued by China Diabetes Association in 2004.MS was diagnosed in case of the personnel exceeded above 3 or more criteria.Their health history was reviewed upon above mentioned parameters for comparison and analysis.Results The crude prevalence of MS was 6.45％ (44 out of 682 cases).The prevalence of MS was 0.00％,4.73％,18.99％ and 25.00％ respectively corresponding to the flying personnel aged over 20,30,40 and 50 years old.The prevalence of obesity,hyper triglyceride,hypertension,raised fasting blood glucose was 39.44 ％,22.29 ％,8.21％,and 1.61％ respectively.Among which,321 personnel were diagnosed as metabolic disorders based on one or more abnormal parameters.The total prevalence of abnormal metabolic index was 47.07％.Conclusions The prevalence of MS is so high in military flying personnel.Overweight,hyper triglyceride and aging have become the high risk factors to MS.It is necessary to take early intervention for preventing MS.

OBJECTIVETo discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle.

METHODSFrom Jan. 2005 to Jun. 2009, 10 cases with small wounds around ankle were treated with medial planta island flaps pedicled with anterior tibial artery perforator. The flap size ranged from 7.5 cm x 2.8 cm to 13.0 cm x 5.0 cm. The wounds at the donor sites were covered with skin grafts.

RESULTSAll the 10 flaps and skin grafts were survived with primary healing. The patients were followed up for 6-12 months with satisfactory cosmetic results. The 2-point discrimination was 4-6 mm when the proximal end of saphenous nerve was not injured, and it was 9-10 mm when the nerve was injured or cut off. The patients could walk with no occurrence of ulcer in flaps or donor site.

CONCLUSIONSThe medial planta island flaps pedicled with anterior tibial artery perforator can effectively repair the small wounds around ankle with reliable blood supply.

Adult ; Ankle Injuries ; surgery ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Skin Transplantation ; Surgical Flaps ; blood supply ; Tibial Arteries ; surgery ; Treatment Outcome ; Young Adult