Background Current clinical decision tools for assessing the risk of symptomatic intracranial hemorrhage (sICH) in patients with vertebrobasilar artery occlusion (VBAO) who received endovascular treatment (EVT) have limited performance. This study develops and validates a clinical risk score to precisely estimate the risk of sICH in VBAO patients. Methods The derivation cohort recruited patients with VBAO who received EVT from the Posterior Circulation IschemIc Stroke Registry in China. Based on the posterior circulation-Alberta Stroke Program Early CT Score (pc-ASPECTS) evaluation method, the cohort was further divided into non-contrast CT (NCCT) and diffusion weighted imaging (DWI) cohorts to construct predictive models. sICH was diagnosed according to the Heidelberg Bleeding Classification within 48 hours of EVT. Clinical signature was constructed in the derivation cohort using machine learning and was validated in two additional cohorts from Asia and Europe. Results We enrolled 1843 patients who underwent EVT and had complete data. pc-ASPECTS of 1710 patients was evaluated on NCCT and 699 patients on DWI. In the NCCT cohort, 1364 individuals made up the training set, of whom 101 (7.4%) developed sICH. In the DWI cohort, the training set consisted of 560 individuals, with 44 (7.9%) experiencing sICH. Predictors of sICH were: glucose, pc-ASPECTS, time from estimated occlusion to groin puncture (EOT), poor collateral circulation, and modified Thrombolysis in Cerebral Infarction (mTICI) score. From these predictors, we derived the weighted poor collateral circulation-EOT-pc-ASPECTS-mTICI-glucose (PEACE) score. The PEACE score showed good discrimination in the training set (area under the curve (AUC) NCCT =0.85; AUC DWI =0.86), internal validation set (AUC NCCT =0.81; AUC DWI =0.82), and two additional external validation set (Asia: AUC NCCT =0.78, AUC DWI =0.80; Europe: AUC NCCT =0.74, AUC DWI =0.78). Conclusion The PEACE score reliably predicted the risk of sICH in VBAO patients who underwent EVT.
BackgroundFew data are available on the clinical features and outcomes of Chinese patients with systemic immunoglobulin light-chain (AL) amyloidosis. The aim of this study is to reveal the clinical picture and risk factors of disease progression in a large cohort of Chinese patients with AL amyloidosis.
The tube-shaped stapler (end-to-end anastomosis, EEA) has been widely employed in surgery of the gastrointestinal tract over the past 10 years in China [1]. This paper reports our experience with the instrument in 150 cases with carcinoma of the esophagus and gastric cardia between December 1981 and June 1985.
A flash imaging lidar based on a multiple-streak tube is presented in this paper; a fiber remapping optics maps light from an area in the focal plane of an imaging lens to multiple rows of fibers on the streak tube’s photocathode. The lidar system contains a multiple-streak tube, laser, transmitting and receiving telescope, remapping optical fibers, and CCD to capture stripe images from the streak tube’s phosphor screen. Data processing yields 48 × 48-pixel intensity and range images for each laser pulse. An experiment to test the property of this lidar is carried out in the laboratory; the intensity images and range images are gained by image remapping, and the range sampling is 0.21 m. Field test imagery demonstrated the capability of the flash lidar system to image a building 705 m away.
Abstract Since 2008, oral propranolol has evolved as the first-line therapy for infantile hemangiomas (IHs). Meanwhile, oral atenolol gradually shows comparative effectiveness versus oral propranolol with few side effects. Here, we conducted a mobile internal survey among a group of Chinese clinicians about how they choose the dosage, dose regimen, and dose escalation methods of propranolol and atenolol for the treatment of IH. A mobile-ready internal survey on the application of oral propranolol and oral atenolol for IH in mainland China was performed and distributed to 333 potential clinicians from different levels of healthcare institutions in mainland China. Eighty-one doctors responded to the survey. All the respondents had the experience of treating IH with oral propranolol and 32 had the experience with oral atenolol. Most of the doctors from tertiary hospitals chose 2 mg/kg/d twice daily, while most of those with the experience of propranolol from private hospitals chose 1 mg/kg/d once daily. More doctors from tertiary hospitals had the experience of atenolol than those from private hospitals. Oral atenolol has become another medication intervention option for IH in mainland China. This survey is helpful to standardize and develop a guideline of oral atenolol therapy for IH.
Objective
To evaluate the prognostic value of hyperintense vessel (HV) in patients with acute middle cerebral artery (MCA) occlusion.
Methods
Seventy-four consecutive patients with first ever stroke(48 male and 26 female, the mean age was (60.7±15.3) years) in the territory of MCA, retrieved from Nanjing Stroke Registry Program between May 2009 and February 2011, were enrolled as subjects. All subjects completed brain MRI, and MRA or DSA indicated proximal MCA occlusion. According to the location and extent of HV, all subjects were classified into 3 groups: without HV, proximal HV and distal HV. Clinical data were obtained and compared among patients with different grades of HV. Logistic regression analysis was employed to confirm the relevant factors of prognosis 90 days after index stroke.
Results
HV was observed in 49 (66.2%) of the 74 enrolled patients. Among patients with HV, 7(9.4%) were classified as proximal HV and 42 (56.8%) as distal HV. Initial NIHSS score (11（1—22）), 10-day NIHSS score (13.5(4—25)), infarction size (＞2/3：5 cases（6.8%）), and 90-day mRS score (3—6 scores: 12 cases（16.2%）) were significantly lower in patients with distal HV than those without (15（6—25）， Z=-3.544；7（0—22）， Z=-4.461；20 cases（27.0%）， χ2=20.916；27 cases（36.5%）， χ2=22.689；all P<0.01). The NIHSS score decreased from baseline to that on 10 days and the mRS score decreased from 10 days to that on 90 days in patients with distal HV was more than that in patients without distal HV. Multivariate analysis revealed that patients with older age (OR= 1.111， 95% CI 1.036—1.191，P=0.003), high infarction size (OR=3.679, 95% CI 1.35—10.025， P=0.011) worsened outcome, whereas distal HV (P=0.012, OR=0.131, 95% CI 0.027—0.638) improved outcome.
Conclusion
Distal HV on FLAIR may predict a favorable outcome in patients with acute middle cerebral artery occlusion.
Key words:
Infarction; middle cerebral artery; Cerebrovascular circulation; Collateral circulation; Magnetic resonance imaging; Prognosis
Objective To examine the expression and significance of nuclear factor-κB(NF-κB) and matrix metalloproteinases-9(MMP-9) in the carotid artery of type 1 diabetes model INS2AKITA rats.Methods Ten INS2AKITA male rats and ten wild-type C57BL/6 male rats in the same litter were selected as Type 1 Diabetes Model group and contrast group,respectively.The two groups were anesthetized and sacrificed at week 16 after inspection of fasting blood glucose and weighing.Hematoxylin and eosin(HE) staining was performed on carotid artery samples taken from the two groups.Immunohistochemistry was performed to examine NF-κB and MMP-9 protein expressions in endothelial cells of the carotid artery.The NF-κB DNA-binding activity of the carotid artery tissues was inspected by electrophoretic mobility shift assay.MMP-9 mRNA in the carotid artery tissue was measured by real-time polymerase chain reaction.Results Compared with the contrast group,blood glucose rose(P < 0.001) and body weight dropped significantly(P < 0.05) in the type I diabetes model group.The HE staining result shows that the two groups have no apparent intimal hyperplasia.The NF-κB and MMP-9 protein expressions in the endothelial cells of the carotid artery of INS2AKITA rats were higher than those of the contrast group,and NF-κB DNA binding activity increased(P < 0.01).Compared with the contrast group,the expression of MMP-9 mRNA in carotid artery of type 1 diabetes model increased(P < 0.05).Conclusions Intimal hyperplasia was not found in the endothelium of the carotid artery of type 1 diabetic rats at week 16.However,NF-κB and MMP-9 protein expression increased.The NF-κB DNA binding activity and MMP-9 mRNA remarkably increased in the carotid artery,which may be possible early abnormal signs for type 1 diabetic atherosclerosis in the carotid artery.
Objective To investigate the safety of implanting sustained release 5-fluorouracil during operation for patients with tumor of the chest.Methods Eighty patients from January 8 to June 10 in 2008 were selected.Sustained release 5-fluorouracil was implanted in 40 cases with tumor of the chest during operation.Forty patients as control group underwent operation alone.The indexes of routine examination pre-and post-operation such as blood indexes,the function of heart,lung,liver and kidney,and the incidence of complications were compared.Results There were no significant differences of blood indexes and the function of heart,lung,liver and kidney between the two groups.There was more fluid drained in the group of sustained release 5-fluorouracil.Differences in other indexes were not found between the two groups.Conclusion Implanting sustained release 5-fluorouracil during operation is a safe and simple therapy with few side effects.
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