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Medicine May 2024Prolonged ventilation is a complication of spontaneous supratentorial hemorrhage patients, but the predictive relationship with successful weaning in this patient cohort... (Observational Study)
Observational Study
Prolonged ventilation is a complication of spontaneous supratentorial hemorrhage patients, but the predictive relationship with successful weaning in this patient cohort is not understood. Here, we evaluate the incidence and factors of ventilation weaning in case of spontaneous supratentorial hemorrhage. We retrospectively studied data from 166 patients in the same hospital from January 2015 to March 2021 and analyzed factors for ventilation weaning. The clinical data recorded included patient age, gender, timing of operation, initial Glasgow Coma Scale (GCS), Intracranial hemorrhage (ICH) score, alcohol drinking, cigarette smoking, medical comorbidity, and the blood data. Predictors of patient outcomes were determined by the Student t test, chi-square test, and logistic regression. We recruited and followed 166 patients who received operation for spontaneous supratentorial hemorrhage with cerebral herniation. The group of successful weaning had 84 patients and the group of weaning failed had 82 patients. The patient's age, type of operation, GCS on admission to the Intensive care unit (ICU), GCS at discharge from the ICU, medical comorbidity was significantly associated with successful weaning, according to Student t test and the chi-square test. According to our findings, patients with stereotaxic surgery, less history of cardiovascular or prior cerebral infarction, GCS >8 before admission to the hospital for craniotomy, and a blood albumin value >3.5 g/dL have a higher chance of being successfully weaned off the ventilator within 14 days.
Topics: Humans; Female; Male; Ventilator Weaning; Middle Aged; Retrospective Studies; Aged; Intracranial Hemorrhages; Glasgow Coma Scale; Adult; Time Factors
PubMed: 38758888
DOI: 10.1097/MD.0000000000038163 -
Medicine May 2024The aim of this study is to assess the impact of intensive risk awareness management along with cardiac rehabilitation nursing in elderly patients with acute myocardial... (Observational Study)
Observational Study
The aim of this study is to assess the impact of intensive risk awareness management along with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart failure. We selected 101 elderly patients with acute myocardial infarction and heart aging treated from January 2022 to March 2023. They were divided into control and observation groups based on hospitalization numbers. The control group (n = 50) received routine nursing, while the observation group (n = 51) received intensive risk awareness management and cardiac rehabilitation nursing. We compared medication possession ratio (MPR), cardiac function, self-care ability scale scores, quality-of-life, incidents, and satisfaction between the 2 groups. Before intervention, there was no significant difference in MPR values between the 2 groups (P > .05). After intervention, MPR values increased in both groups, with a greater increase in the observation group (P < .05). Cardiac function showed no significant difference before intervention (P > .05), but after intervention, the observation group had lower left ventricular end-systolic and diastolic diameters and higher left ventricular ejection fraction compared to the control group (P < .05). Self-care skills, health knowledge, self-responsibility, and self-concept scores improved in both groups after intervention, with higher scores in the observation group (P < .05). The observation group had higher scores in various quality-of-life domains (P < .05). The total incidence of adverse events was lower in the observation group (5.88%) compared to the control group (20.00%) (P < .05). Patient satisfaction was significantly higher in the observation group (96.08%) than in the control group (84.00%) (P < .05). Intensive risk awareness management combined with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart aging can enhance medication compliance, improve quality-of-life, enhance self-care abilities, boost cardiac function, reduce incidents, and increase patient satisfaction.
Topics: Humans; Male; Female; Aged; Heart Failure; Myocardial Infarction; Quality of Life; Cardiac Rehabilitation; Aged, 80 and over; Self Care; Patient Satisfaction; Medication Adherence; Health Knowledge, Attitudes, Practice
PubMed: 38758887
DOI: 10.1097/MD.0000000000037381 -
Alternative Therapies in Health and... May 2024To analyze the role of real-time 3-dimensional echocardiography (RT-3DE) in evaluating in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) in...
OBJECTIVE
To analyze the role of real-time 3-dimensional echocardiography (RT-3DE) in evaluating in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).
METHODS
This study enrolled 62 AMI patients (research group) and 51 healthy volunteers (control group) who presented to The First Affiliated Hospital of Zhejiang University between October 2021 and December 2022. Differences in RT-3DE parameters between the two groups and changes in RT-3DE parameters before and after PCI in the research group were compared. The patients were followed up for 6 months after PCI to analyze the evaluation effect of RT-3DE parameters on post-PCI ISR.
RESULTS
After PCI, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), displacement standard deviation (Esd) in both groups, maximum displacement value (Emax), and LV synchronization parameters were all reduced and were higher in the study group than in the control group (P < .05). The left ventricular ejection fraction (LVEF), peak ejection rate (PER), peak filling rate (PFR), average motion amplitude (Eavg), minimum displacement value (Emin), and left ventricular synchronization parameters were all lower in the study group than in the control group (P < .05). The LVEDV and Tmsv16-SD/R-R were found to be higher in patients with ISR 6 months after PCI than in those without ISR, while LVEF and Emin were lower (P < .05). ROC curve analysis revealed that all four parameters exhibited excellent prediction efficiency for the occurrence of ISR, among which LVEF had the best performance.
CONCLUSIONS
RT-3DE parameters play an excellent role in predicting the occurrence of post-PCI ISR in AMI patients.
PubMed: 38758140
DOI: No ID Found -
The Lancet Regional Health. Europe Jun 2024
PubMed: 38757114
DOI: 10.1016/j.lanepe.2024.100933 -
BMJ Neurology Open 2024Fibrocartilaginous embolism (FCE) is a rare spinal cord infarction due to embolism of fibrocartilaginous material with consecutive arterial infarction of the anterior...
INTRODUCTION
Fibrocartilaginous embolism (FCE) is a rare spinal cord infarction due to embolism of fibrocartilaginous material with consecutive arterial infarction of the anterior spinal artery. Physical activity with increased axial pressure is the underlying mechanism of the retrograde migration of primarily nucleus pulposus material into the arterial system of the spinal cord. The initial severity of the clinical symptoms is supposed to be a prognostic predictor of recovery and so far, no specific treatment recommendation exists.
METHODS
We present a case of spinal cord infarction due to FCE after long and sporty mountain cycling (during 6 hours and 2500 altitude difference) with detailed clinical and radiological follow-up.
RESULTS
The clinical and radiological follow-up at month 4 showed an unexpected almost complete recovery despite the extensive initial clinical impairment.
CONCLUSION
Mountain cycling has not yet been described as a specific trigger of FCE with spinal cord infarction. Further observation is necessary to show if the prolonged bent posture and core muscle imbalance in cycling, in addition to the Valsalva manoeuvre during physical effort, may contribute to FCE. It is unknown if prognosis of spinal cord infarction due to FCE differs from other causes of spinal ischaemia and if anticoagulation treatment presents a therapeutic option.
PubMed: 38757111
DOI: 10.1136/bmjno-2024-000690 -
Frontiers in Pharmacology 2024Neuroinflammation plays a key role in the progression of secondary brain injury after ischemic stroke, and exosomes have been increasingly recognized to eliminate...
Neuroinflammation plays a key role in the progression of secondary brain injury after ischemic stroke, and exosomes have been increasingly recognized to eliminate inflammatory responses through various mechanisms. This study aimed to explore the effect and possible mechanism of human umbilical vein endothelial cells derived exosomes (H-EXOs) on neuroinflammation. We established a transient middle cerebral artery occlusion/reperfusion (tMCAO/R) in male rats and oxygen-glucose-deprivation/reoxygenation (OGD/R) model in cultured neurons to mimic secondary brain injury after ischemic stroke . H-EXOs were administered at the same time of reperfusion. Results showed that the production of pro-inflammatory cytokines TNF-α, IL-1β, and IL-6, and the transcription factor Krüppel-like factor 14 (KLF14) were significantly increased both in rat brain tissue and cultured neural cells after ischemic-reperfusion (I/R) injury. H-EXOs treatment significantly improved the cultured cell viability, reduced infarct sizes, mitigated neurobehavioral defects, and alleviated the expression of pro-inflammatory cytokines compared with the control group, indicating that H-EXOs exerted anti-inflammatory effect against I/R injury. Further studies revealed that the anti-inflammatory effect of H-EXOs could be weakened by small-interfering RNA (siKLF4) transfection. KLF14 was a protective factor produced during cerebral ischemia-reperfusion injury. In conclusion, H-EXOs protect neurons from inflammation after I/R injury by enhancing KLF14 expression.
PubMed: 38756375
DOI: 10.3389/fphar.2024.1365928 -
SAGE Open Medical Case Reports 2024The falciform ligament, a peritoneal fold that anatomically separates the right and left lobes of the liver, may infrequently be a cause of patients' complaints. In very...
The falciform ligament, a peritoneal fold that anatomically separates the right and left lobes of the liver, may infrequently be a cause of patients' complaints. In very rare instances, fatty appendages of the falciform ligament may undergo torsion, resulting in fat infarction. Despite its rarity, falciform ligament pathologies often mimic common abdominal issues, leading to misdiagnosis. Herein, we report a case of inflammation and necrosis of the falciform ligament in a 72-year-old female. The patient presented with abdominal pain, a positive Murphy's sign, and elevated inflammatory markers. Imaging, including a computed tomography (CT) scan, was pivotal in confirming the diagnosis of falciform ligament necrosis. Contrary to the proposed surgical approach (resection of the falciform ligament) in some reported cases, conservative management (including analgesia, hydration, and antibiotics) proved successful in this case. This report emphasizes the importance of considering falciform ligament torsion in upper abdominal pain differential diagnoses and highlights the key role of imaging for accurate diagnosis.
PubMed: 38756333
DOI: 10.1177/2050313X241252738 -
Frontiers in Neurology 2024Early blood-brain barrier (BBB) disruption in patients with acute ischemic stroke (AIS) can be detected on perfusion computed tomography (PCT) images before undergoing...
BACKGROUND AND PURPOSE
Early blood-brain barrier (BBB) disruption in patients with acute ischemic stroke (AIS) can be detected on perfusion computed tomography (PCT) images before undergoing reperfusion therapy. In this study, we aimed to determine whether early disruption of the BBB predicts intracranial hemorrhage transformation (HT) in patients with AIS undergoing endovascular therapy and further identify factors influencing BBB disruption.
METHODS
We retrospectively analyzed general clinical and imaging data derived from 159 consecutive patients with acute anterior circulation stroke who were admitted to the Department of Neurology of the First Hospital of Jilin University, and who underwent endovascular treatment between January 1, 2021, and March 31, 2023. We evaluated the relationship between BBB destruction and intracranial HT before endovascular reperfusion therapy and examined the risk factors for early BBB destruction.
RESULTS
A total of 159 patients with assessable BBB leakage were included. The median (interquartile range, IQR) age was 63 (54-70) years, 108 (67.9%) patients were male, and the median baseline National Institutes of Health Stroke Scale (NHISS) score was 12 (10-15). Follow-up non-contrast computed tomography (NCCT) detected HT in 63 patients. After logistic regression modeling adjustment, we found that BBB leakage in the true leakage area was slightly more than 2-fold risk of HT (odds ratio [OR], 2.01; 95% confidence interval [CI] 1.02-3.92). Heart rate was also associated with HT (OR, 1.03, 95% CI, 1.00-1.05). High Blood-brain barrier permeability (BBBP) in the true leakage area was positively correlated with infarct core volume (OR, 1.03; 95% CI, 1.01-1.05).
CONCLUSION
Early BBB destruction before endovascular reperfusion therapy was associated with HT, whereas high BBBP correlated positively with infarct core volume.
PubMed: 38756220
DOI: 10.3389/fneur.2024.1349369 -
Frontiers in Neurology 2024This research aims to explore the trends and knowledge domain of acupuncture for cerebral infarction through bibliometrics.
OBJECTIVE
This research aims to explore the trends and knowledge domain of acupuncture for cerebral infarction through bibliometrics.
METHODS
Publications related to acupuncture for cerebral infarction were retrieved from the Web of Science core collection database from 1993 to December 31, 2023. A domain knowledge graph was then constructed using VOSviewer, CiteSpace, GraphPad Prism, and Scimago Graphica.
RESULTS
The cumulative publication trend shows a steady increase over the years, with China being the most productive country. Notably, Europe exhibits significant close collaboration. Institutional cooperation is primarily observed among Chinese universities specializing in traditional Chinese medicine. Tao Jing is the most prolific author, with his highest number of publications is in "Stroke" journal, and Acupuncture Electro Therapeutics Research is the significant journal. Zhang SH is the most cited author, and Si QM is a prominent author in this field. Rehabilitation treatment after cerebral infarction emerges as a prevalent research focus, with nerve regeneration being a keyword. Long EZ's 1989 paper, published in the journal Stroke, holds significant importance. The prominent papers are Donnan et al. and Wu et al., which covers the following topics: "population-based study," "Baihui Acupoint," "memory deficits," "neurotrophic factor," and "randomized trial."
CONCLUSION
This bibliometric analysis of acupuncture for cerebral infarction offers insights into the Web of Science database, delineates a knowledge map of countries, authors, institutions, cited authors, keywords, cited references in the field of acupuncture for cerebral infarction, which has a momentous guiding significance for quickly and accurately positioning the key information in the field.
PubMed: 38756219
DOI: 10.3389/fneur.2024.1386164 -
Cardiovascular Diabetology May 2024Insulin resistance (IR) is linked to both the complexity of coronary artery lesions and the prognosis of acute coronary syndrome (ACS). However, the precise extent of... (Observational Study)
Observational Study
BACKGROUND
Insulin resistance (IR) is linked to both the complexity of coronary artery lesions and the prognosis of acute coronary syndrome (ACS). However, the precise extent of this correlation and its impact on adverse cardiovascular outcomes in ACS patients remain unclear. Therefore, this study aims to investigate the intricate relationship between IR, coronary artery lesion complexity, and the prognosis of ACS through a cohort design analysis.
METHOD
A total of 986 patients with ACS who underwent percutaneous coronary intervention (PCI) were included in this analysis. IR was assessed using the triglyceride-glucose (TyG) index, while coronary artery lesion complexity was evaluated using the SYNTAX score. Pearson's correlation coefficients were utilized to analyze the correlations between variables. The association of the TyG index and SYNTAX score with major adverse cardiovascular events (MACEs) in ACS was investigated using the Kaplan-Meier method, restricted cubic splines (RCS), and adjusted Cox regression. Additionally, a novel 2-stage regression method for survival data was employed in mediation analysis to explore the mediating impact of the SYNTAX score on the association between the TyG index and adverse cardiovascular outcomes, including MACEs and unplanned revascularization.
RESULTS
During a median follow-up of 30.72 months, 167 cases of MACEs were documented, including 66 all-cause deaths (6.69%), 26 nonfatal myocardial infarctions (MIs) (2.64%), and 99 unplanned revascularizations (10.04%). The incidence of MACEs, all-cause death, and unplanned revascularization increased with elevated TyG index and SYNTAX score. Both the TyG index (non-linear, P = 0.119) and SYNTAX score (non-linear, P = 0.004) displayed a positive dose-response relationship with MACEs, as illustrated by the RCS curve. Following adjustment for multiple factors, both the TyG index and SYNTAX score emerged as significant predictors of MACEs across the total population and various subgroups. Mediation analysis indicated that the SYNTAX score mediated 25.03%, 18.00%, 14.93%, and 11.53% of the correlation between the TyG index and MACEs in different adjusted models, respectively. Similar mediating effects were observed when endpoint was defined as unplanned revascularization.
CONCLUSION
Elevated baseline TyG index and SYNTAX score were associated with a higher risk of MACEs in ACS. Furthermore, the SYNTAX score partially mediated the relationship between the TyG index and adverse cardiovascular outcomes.
Topics: Humans; Acute Coronary Syndrome; Male; Female; Insulin Resistance; Middle Aged; Aged; Percutaneous Coronary Intervention; Risk Assessment; Risk Factors; Treatment Outcome; Blood Glucose; Time Factors; Biomarkers; Coronary Artery Disease; Triglycerides; Retrospective Studies; Predictive Value of Tests
PubMed: 38755609
DOI: 10.1186/s12933-024-02276-1