The aim of the study was to assess the efficacy of low-frequency electrotherapy (LFE) for female patients with early-stage detrusor underactivity (DUA) due to neuromuscular deficiency. A total of 102 female patients were divided randomly into four groups: LFE-NC (normal compliance), LFE-LC (low compliance), CON (control)-NC and CON-LC. Patients in the LFE-NC and LFE-LC groups received LFE, and those in the CON-NC and CON-LC groups received conservative treatment. Urodynamic evaluation was performed before and after treatment. After treatment, 82 % of the LFE-NC regained detrusor contractility, whereas only 2 (8 %) of the CON-NC had normal detrusor contraction. None of LFE-LC or CON-LC regained detrusor contractility (p < 0.01). The per cent of LFE-NC who relied on catheterization for bladder emptying decreased by 43 % (p < 0.01). Those in the LFE-LC, CON-NC and CON-LC groups decreased by only 4, 12 or 0 % (p > 0.05). LFE was more effective for DUA patients with normal compliance; these patients benefited from LFE, but DUA patients with low compliance did not.
This study aims to investigate the characteristics and influencing factors of cognitive impairment in patients with asymptomatic middle cerebral artery stenosis (aMCAS) and to construct a nomogram to predict the risk of cognitive impairment in patients with aMCAS.We collected 54 patients with aMCAS and 35 healthy controls to investigate the impaired cognitive domains and pathogenesis in patients with aMCAS. All patients underwent a cranial MRI, CT perfusion, transcranial Doppler ultrasound, blood tests, and a comprehensive neuropsychological evaluation. According to the MoCA score, patients were divided into cognitively normal and cognitively impaired groups. To construct the nomogram, we conducted univariate and multivariate logistic regression analyses to identify factors that affect cognitive function. And the performance of nomogram was evaluated by ROC curves, calibration curves, decision curve analysis (DCA), and clinical impact curve (CIC).In 54 patients with aMCAS, 24 patients presented with cognitive normal, and 30 patients presented with cognitive impairment. The results of multivariate logistic regression suggested that perfusion decompensation, middle cerebral artery mean flow velocity, and LDL-cholesterol levels were independent influencing factors of cognitive impairment. In the following step, a nomogram was constructed. The AUC of the nomogram is 0.862. Calibrating curves show good agreement between nomogram predictions and actual observations, while DCA and CIC show great clinical usefulness.Patients with aMCAS have cognitive impairment in multiple cognitive domains, and impaired executive function was observed during the perfusion compensation period. Furthermore, a nomogram was constructed and validated to predict the risk of cognitive impairment in patients with aMCAS, which can help clinicians to identify at an early stage and improve the management of patients.
Abstract The association between blood pressure and intracranial artery stenosis (ICAS) in different age groups has not been elucidated. Using data from the “China Hypertension Survey,” we conducted a cross‐sectional analysis of the association between blood pressure parameters and ICAS. In this study, participants older than 35 years were selected by stratified, multistage random sampling. Blood pressure was measured repeatedly at rest, and ICAS was assessed by transcranial doppler ultrasound. Binary logistic regression analysis was used to demonstrate the association between different blood pressure indicators and ICAS. Of the 3640 participants included (mean age 63 ± 13 years old, 57.8% female), systolic blood pressure (SBP) and pulse pressure (PP) were associated with ICAS in the general population; the multivariable adjusted odds ratio (OR) and corresponding 95% confidence interval (95% CI) of ICAS and multivessel stenosis were 1.32 (1.21, 1.45) and 1.29 (1.14, 1.46) per standard deviation (SD) increase in SBP and 1.44 (1.30, 1.59) and 1.52 (1.33, 1.74) for PP, respectively. Further analysis of this association in different age groups revealed inconsistent results between SBP and ICAS. Prehypertension (120 ≤ SBP < 140) could predict ICAS in the older group but not in the younger group, and the positive association between SBP and multivessel stenosis disappeared in the younger age group ( P > .05 in all SBP subgroups). In conclusion, SBP and PP could not only identify ICAS in the middle‐aged and elderly population but could also provide some information about ICAS burden; however, these associations need to be interpreted differentially based on age subgroup.
To present a case with aorta coarctation complicated by aortic arch aneurysm which is clinical rare and entails a high risk of rupture.Here we reported a 46-year-old female patient diagnosed with aortic arch aneurysm combined with coarctation.The computed tomography angiography shows that an irregular aneurysm was located at the aortic arch site with its maximal diameter 86.55 mm and the right end of aneurysm was located 10 mm away from the ostium of left common carotid artery (LCCA).The aneurysm body invaded the left subclavian artery, and at the distal end of aneurysm a coarctation had been observed with a minimum diameter reaching 2.7 mm.We performed percutaneous balloon angioplasty, thoracic endovascular aortic repair to exclude the aneurysm, and simultaneously used a novel in situ fenestration device (Quick-Fenestrater) to revascularize the covered LCCA.This is first case of using a novel fenestration device single-stage endovascular treatment of complicated thoracic aorta coarctation concurrent with aortic arch aneurysm.Combined endovascular techniques can elevate the success rate of reconstruct complicated aorta aneurysm concurrent with coarctation and reduce complications.Under the guidance of Quick-Fenestrater, in situ fenestration could be performed with safety and a high success frequency.
BACKGROUND : Endoscopic submucosal dissection (ESD) has been widely used to treat superficial esophageal neoplasms (SENs). Intraoperative bleeding is one of the main concerns that makes ESD in the esophagus more difficult and time consuming with higher complication rates. We introduced a novel laser endoknife system that enabled better intraoperative hemostasis, and preliminarily investigated its feasibility in ESD for patients with SENs.17 consecutive patients with SENs were prospectively enrolled. The laser endoknife system was used in marking and submucosal dissection. Data on therapeutic outcomes were collected and analyzed.The median diameter of the lesions was 2.5 cm and of the resected specimens was 3.0 cm. The median procedure time was 48 minutes. Histologic evaluation revealed 15 high grade intraepithelial neoplasias and two squamous cell carcinomas. No intraoperative bleeding occurred during laser cutting and no significant complications occurred postoperatively. Curative R0 resection was achieved in all patients.Our new laser endoknife system was feasible in the submucosal dissection of SENs and showed great prospects for future application.
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