To valuate cerebral protection by retrograde cerebral perfusion (RCP) via superior vena cava,the study results for the last ten years have been reviewed.RCP is regarded as an assistant method in deep hypothermic circulatory arrest(DHCA) in that it provides partial brain blood flow,maintains a low brain temperature,optimizes cerebral metabolic function during DHCA by supplying oxygen and some nutrient and removal of catabolic products;it also reduces the incidence of cerebral embolization by flushing out air...
ObjectiveTo systematically review the effectiveness and safety of argatroban for patients with acute ischemic stroke. MethodsPubMed (1966 to 2013.12), EMbase (1966 to 2013.12), CENTRAL (2013.12), CBM (1978 to 2013.12), VIP (1989 to 2013.12), CNKI (1980 to 2013.12) and CDFD (for masters and Phds, 1999 to 2013.12) were electronically searched for randomized controlled trials (RCTs) on argatroban for patients with acute ischemic stroke. Meanwhile, relevant data were retrieved by hand search and the data from pharmaceutical factories (TIPR Pharmaceutical Responsible Co. Ltd) were collected. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 11 RCTs involving 889 patients were finally included. The results of meta-analysis showed that the argatroban group was better than the control group in improving patients' neurologic impairment scores (SMD=0.71, 95%CI 0.56 to 0.88, P < 0.000 01), and the effectiveness of neurological function (total result:OR=2.65, 95%CI 1.84 to 3.80, P < 0.000 01; placebo-controlled trial:OR=2.18, 95%CI 1.27 to 3.72, P=0.004; non-placebo-controlled trial:OR=3.09, 95%CI 1.89 to 5.06, P < 0.000 01), all with significant differences. No significant difference was found between the argatroban group and the control group in the long/short-term motilities or dependence rates as well as in the incidence of adverse reaction (OR=1.55, 95%CI 0.60 to 4.01, P=0.37). ConclusionCurrent evidence shows that argatroban could improve neurologic impairment of patients with acute ischemic stroke without severe bleeding events or other adverse reaction. However, further studies are needed to confirm its effects on reducing rates of death and disability in treating acute ischemic stroke.
Objective To assess the effectiveness and safety of sodium ozagrel combined with edaravone for cerebral infarction. Methods Such databases as PubMed (1995 to 2010), EMCC (1995 to 2010), CBM (1995 to 2010), CNKI (1995 to 2010), and VIP (1989 to 2010) were searched to collect randomized controlled trials (RCTs) of odium ozagrel combined with edaravone for cerebral infarction. Then the retrieved studies were screened according to the predefined inclusion and exclusion criteria, the data were extracted, the quality of the included studies was evaluated, and meta-analyses were performed by using the Cochrane Collaboration’s RevMan 5.0 software. Results A total of 32 RCTs involving 3 059 cases were involved, among which 1 559 cases were in the treatment group and the other 1500 were in the control group. All studies with comparable baseline data reported the application of random methods without explaining the detailed methods, the blinding method and the allocation concealment. The results of meta-analyses indicated that sodium ozagrel combined with edaravone had significant differences in the effective rate for cerebral infarction compared with both single sodium ozagrel (OR=3.51, 95%CI 2.70 to 4.57) and routine treatment (OR=3.77, 95%CI 2.58 to 5.52), and it had significant differences in treating the defect of neurological function compared with both sodium ozagrel (WMD= –4.26, 95%CI –4.97 to –3.55) and routine treatment (WMD= –3.89, 95%CI –4.96 to –2.82). In addition, Sodium ozagrel combined with edaravone was superior to sodium ozagrel (WMD=13.57, 95%CI 9.84 to 17.30) in improving the ability of daily living. Conclusion This systematic review shows that sodium ozagrel combined with edaravone is quite effective in treating cerebral infarction, and it can improve the nerve dysfunction. This conclusion should be treated cautiously for the poor quality and higher possibility of bias in the included studies which may impact on the power of proof, so more double-blind RCTs with high quality are expected to provide high-quality evidence.
Cerebral small vessel disease (CSVD) encompasses a group of progressive disorders involving the small vessels of the brain with complex etiologies. Inflammation plays a pivotal role in both the onset and progression of CSVD. In age-related CSVD, chronic inflammation can exacerbate brain tissue damage by impairing endothelial function and disrupting the blood-brain barrier. In contrast, in inflammatory CSVD subtypes driven primarily by immune dysregulation, inflammation itself constitutes the core pathogenic mechanism. These subtypes present with diverse clinical manifestations, posing significant challenges for diagnosis and treatment. A deeper understanding of the inflammatory mechanisms involved in CSVD and the unresolved issues in this field may provide new avenues for personalized interventions and improved prognosis.
ObjectiveTo evaluate the differences of visual evoked potentials (amplitudes and latency) between cerebral palsy (CP) children and normal children. MethodsThis study involved fourteen children aged from 4 to 7 years with CP (monoplegia) between 2009 and 2013. Another 14 normal children aged from 5 to 9 years treated in the Department of Ophthalmology in West China Hospital during the same period were regarded as the control group. Both eyes of all the participants were examined by multifocal visual evoked potential (mfVEP). The mfVEP examination results were recorded, and amplitude and latency were analyzed. First, we analyzed the differences of amplitudes and latency time between monoplegia children and children in the control group. Second, gross motor function classification system (GMFCS) was used to classify the fourteen monoplegia children among whom there were five GMFCS Ⅰ patients and nine GMFCS Ⅱ patients. The differences of mfVEP were analyzed between the two GMFCS groups. ResultsThe amplitude and latency of mfVEP in children with CP showed gradual changes similar to those in the normal children. The amplitudes were decreasing and the latencies were delaying from the first eccentricity to the sixth eccentricity. The amplitudes in children with CP were lower than those in the control group in the first to the third eccentricities for both eyes (P＜0.05), and latency of left eye was delayed in the first eccentricity in children with CP (P=0.045). No difference was found between the two GMFCS groups (P>0.05) except the amplitude of the first eccentricity (P=0.043). ConclusionsThe results of mfVEP show significant differences of amplitude and latency between CP and normal children, suggesting the existence of visual pathway impairments in cerebral palsy children. The results of mfVEP can provide an objective basis of visual impairments for cerebral palsy children.
Objective To discuss the optimal time for operation in patients with malignant middle cerebral artery (MCA) syndrome. Method The relation between effectiveness and operating time was analyzed in 47 patients to compare the effects of early and delayed operation by SPSS10.0. Results Among 27 patients undergoing early operation, 18 were cured or restored, 4 seriously disabled and 5 died. While among 20 patients undergoing delayed operation, only 9 were cured or restored, 4 seriously disabled and 7 died. The prognosis of delayed operation group was worse than that of early operation group. Conclusions Selecting the optimal time to operate may decrease the mortality and morbidity of MCA syndrome.
The main magnetic field, generated by the excitation coil of the magnetic induction phase shift technology detection system, is mostly dispersed field with small field strength, and the offset effect needs to be further improved, which makes the detection signal weak and the detection system difficult to achieve quantitative detection, thus the technology is rarely used in vivo experiments and clinical trials. In order to improve problems mentioned above, a new Helmholtz birdcage sensor was designed. Stimulation experiment was carried out to analyze the main magnetic field in aspects of intensity and magnetic distribution, then different bleeding volume and bleeding rates experiments were conducted to compared with traditional sensors. The results showed that magnetic field intensity in detection region was 2.5 times than that of traditional sensors, cancellation effect of the main magnetic field was achieved, the mean value of phase difference of 10 mL rabbit blood was (–3.34 ± 0.21)°, and exponential fitting adjusted R2 between phase difference and bleeding volumes and bleeding rates were both 0.99. The proposed Helmholtz birdcage sensor has a uniform magnetic field with a higher field strength, enable more accurate quantification of hemorrhage and monitored change of bleeding rates, providing significance in magnetic induced technology research for cerebral hemorrhage detection.
Abstract： Objective To investigate the cerebral protective effects of hyperoxia management during deep hypothermia circulatory arrest（DHCA） rabbit by the blood gas indexes, superoxide dismutase（ SOD） activity and malondialdehyde （MDA） levels of brain, and ratio of water to brain. Methods A DHCA and antegrade selective cerebral perfusion （ASCP） rabbit model was established. Twenty-four 11-13 week-old male New Zealand rabbits（ weighing 2.7 to 3.4 kg） were assigned to three groups with a random number table: a sham operation group （Sham group）, an ASCP group （S group）, and an ASCP ＋ hyperoxia management group （SH group）. There were eight rabbits in each group. We recorded the intraoperative values for arterial oxygen pressure （PaO2）, arterial oxygen saturation （SaO2）, jugular venous oxygen pressure（PjvO2）, jugular venous oxygen saturation（ SjvO2） and blood lactate level. The brain SOD activity, MDA levels, and ratio of water to brain were measured after the operation. Results Before initiating circulatory arrest, before initiating reperfusion and five minutes of reperfusion, levels of PaO2 , PjvO2 , and SjvO2 in the SH group were significantly higher than those of the S group and Sham group. SOD activity in the SH group was not significantly different from that of the S group[（213.53±33.52） U/mg. prot vs. （193.02±27.67） U/mg. prot] and Sham group[（213.53±33.52） U/mg. prot vs.（244.38±35.02）U/mg. prot], but the SOD activity in the S group was lower than that in the Sham group（ P ＜ 0.05）. MDA levels in the SH group were lower than that in the S group[（1.42±0.30） nmol/mg. prot vs. （2.37±0.55） nmol/mg. prot, P ＜ 0.05]. Conclusion Our data show that hyperoxia management during DHCA＋ASCP improves rabbits’PjvO2 and SjvO2, maintains brain SOD activity, and decreases brain MDA levels, demonstrating the neuroprotective effects of hyperoxia mangagement.
ObjectiveTo explore the clinical effect of comprehensive nursing on cerebral infarction patients with high blood glucose. MethodsEighty cerebral infarction patients with high blood glucose treated between March 2012 and February 2013 were divided into observation group and control group with 40 patients in each. Patients in the control group received routine nursing care, while those in the observation group were given comprehensive nursing care. Then, we compared the two groups of patients in terms of their blood glucose control level, the recovery of neurological function and life quality. ResultsThe fasting glucose, 2-hour postprandial blood glucose, National Institude of Health stroke scale (NIHSS), and modified Edinburgh Scandinavican scoring scale (MESSS) scores of the two groups were not statistically different at the time of hospital admission (P>0.05). However, fasting blood sugar, 2-hour postprandial blood glucose, NIHSS, and MESSS scores in the observation group were significantly lower than those in the control group before discharge (P<0.05). Life quality score of self-care, mental health, and social function before discharge in the observation group were significantly higher than those in the control group (P<0.05). ConclusionComprehensive nursing is helpful to control blood glucose in an ideal level range for cerebral infarction patients with hyperglycemia, which can also promote the recovery of neurological function and improve the life quality of patients.
Objective To compare the outcome of patients with the strategy of conventional and steady cooling ＆ rewarming and cold reperfusion , who suffered from DeBakey type Ⅰ aortic dissection or aortic arch aneurysm and underwent the total aortic arch replacement. Methods Thirty-two patients who underwent total arch replacement were randomly allocated to one of two strategies of temperature management in cardiopulmonary bypass （CPB）, conventional group （group C, 16 cases） and steady cooling ＆. rewarming and cold reperfusion group （group S, 16 cases）. The jugular bulb venous oxygenation saturation （SjvO2）, jugular bulb venous oxygen tension （PivO2） and jugular bulb venous blood temperature （JVBT） were tested or monitored during the operation. Preoperative and postoperative neurological examinations and brain computerized tomography scan were performed. Results All patients survived the operations and were discharged from hospital. No new brain infarction occurred. Transient neurologic dysfunction occurred in 2 patients of the group S and 3 patients of the groupC. The “cooling ＆ rewarming blanket-impress puple” occurred in 4 cases of the group C. The SjvO2, PjvO2, lowest nasopharyngeal temperature and the post operative nasopharyngeal temperature of the patients in group S were significantly higher than those of the patients in group C （SjvO2 0.85±0. 11 vs. 0. 74±0.23, PjvO2 36. 9± 15.6mmHg vs. 24.5±7.7mmHg, P（ 0.01 ）. While the highest brain temperature, wake time and ICU stay in group S were remarkably lower than those in group C （P 〈0. 01,0. 05）. Conclusion With less postbypass afterdrop and satisfactory clinical outcome, the strategy of steady cooling ＆ rewarming and cold reperfusion can effectively avoid brain hyperthermia and mismatch of cerebral blood flow metabolism in the surgery of total aortic arch replacement.