Post-stroke cognitive impairment (PSCI) which has been a barrier to the rehabilitation, could be prevented and treated. Early assessment of cognitive impairment, as well as diagnosis and comprehensive interventions of PSCI would improve rehabilitation of stroke patients. The rehabilitation, as an important component of the comprehensive intervention, could improve cognitive function, delay disease progression, and optimize the daily life. The widely-used rehabilitation methods include cognitive intervention, exercise training, music therapy, and neuromodulation techniques, etc. Comprehensive cognitive training covering multiple cognitive domains and multimodal intervention can significantly improve the overall cognitive function of patients. The research in the PSCI field is still in its infancy in China. Thus, It is necessary to pay more attention to the PSCI clinically, and unveil the unkown area in PSCI.
Objective To study the expressions of phosphatese and tensin homolog deletedin chromosom ten （PTEN）, Fas/FasL system and matrix metalloproteinnases-2 （MMP-2） in human gastric cancer. Methods Seventy-five cases of gastric carcinoma were selected from paraffin wax embodied specimens with full clinicopathological data, and another 15 cases of normal gastric mucosa specimens were selected as the control group. SP immunohistochemistry was used to measure the expressions of PTEN， Fas/FasL and MMP-2 in them. The data was statistically analyzed by χ2 test and relative analysis. Results The expressions of PTEN, Fas/FasL and MMP-2 were correlated with the lymphatic metastasis, degree of infiltration, clinical TMN stage and pathological histological differentiated degree of gastric cancer (Plt;0.05). PTEN was positive correlated with Fas/FasL (r=0.401, Plt;0.001). MMP-2 was negative correlated with Fas/FasL (r=－0.720， Plt;0.001). MMP-2 was negative correlated with PTEN (r=－0.336， Plt;0.001). Conclusion There is guidance meaning in testing the expressions of PTEN, Fas/FasL and MMP-2 in gastric cancer to estimate the prevention, diagnoses, therapy and prognosis of gastric cancer.
Objective To determine risk factors of delayed recovery of consciousness after aortic arch surgery underdeep hypothermic circulatory arrest （DHCA） and antegrade selective cerebral perfusion （ASCP）. Methods We retrospectively analyzed clinical data of 113 patients who underwent aortic arch surgery under DHCA＋ASCP in the Affiliated Drum Tower Hospital， Medical School of Nanjing University from October 2004 to April 2012. According to whether they regained consciousness within 24 hours after surgery， all the 113 patients were divided into normal group （73 patients including 55 males and 18 females with their average age of 48.1±10.9 years） and delayed recovery group （40 patients including 29 males and 11 females with their average age of 52.2±11.4 years）. Risk factors of delayed recovery of consciousness after surgery were evaluated by univariate analysis and multivariate logistic regression analysis. Results Nine patients （8.0%） died postoperatively， including 5 patients with multi-organ failure， 2 patients with heart failure， 1 patient with mediastinal infection， and 1 patient with pulmonary hemorrhage. There were 7 deaths （17.5%） in the delayed recovery group and 2 deaths （2.7%） in the normal group， and the in-hospital mortality of the delayed recovery group was significantly higher than that of the normal group （P=0.016）. A total of 94 patients （including 65 patients in the normal group and 29 patients in the delayed recovery group） were followed up for 4-95 months. Eight patients （including 5 patients in the normal group and 3 patients in the delayed recovery group） died during follow-up， including 2 patients with stroke， 3 patients with heart failure， 2 patients with pulmonary hemorrhage and 1 patient with unknown cause. Ten patients were lost during follow-up. Univariate analysis showed that age （P=0.042）， hypertension （P=0.017）， emergency surgery （P=0.001）， cardiopu- lmonary bypass （CPB） time （P=0.007）， aortic cross-clamp time （P=0.021）， and blood transfusion（P=0.012）were risk factors of delayed recovery of consciousness after aortic arch surgery. Multivariate logistic regression showed that emergency surgery （P=0.005） and CPB time＞240 minutes （P=0.000） were independent risk factors of delayed recovery of consciousness after aortic arch surgery. Conclusion Delayed recovery of consciousness after aortic arch surgery is attributed to a combination of many risk factors. Correct patient diagnosis， lesion site and involved scope should be made clear preoperatively in order to choose appropriate surgical strategies. During the surgery， strengthened brain protection， shortened operation time， improved surgical techniques， and perioperative stable circulation maintenance are all important measures to prevent delayed recovery of consciousness after aortic arch surgery.
Object ive To summar ize recent advance in the appl icat ion and research of ar t i f icial chordae tendineae. Methods The cl inical and experimental research l iterature was extensively reviewed and analyzed. Results The follow-up results showed that artificial chordae tendineae replacement was superior to other operation methods in valve repair. But, it was compl icated and difficult-to-learn. In recent years with the development of many surgical skills and new techniques, good cl inical results were achieved. Conclusion With the development of surgical equi pment, chordae material, and implanting skills, artificial chordae tendineae implanting will be easier and the scope of appl ication will be larger.
Objective To discuss left ventricular reconstruction methods and effectivness in patients with left ventricular aneurysm after myocardial infarction. Methods Between June 2003 and August 2008, 23 patients with left ventricular aneurysm after myocardial infarction were treated. Of them, 13 were male and 10 were female with an average age of 61.2 years (range, 47-74 years). According to New York Heart Association (NYHA) criteria for cardiac function, there were 3 cases of grade I, 6 cases of grade II, 10 cases of grade III, and 4 cases of grade IV. The coronary arteriongraphy showed singlevesseldisease in 2 cases, double-vessel disease in 5 cases, triple-vessel disease in 16 cases. The locations of ventricular aneurysm were the apex cordis in 18 cases, antetheca and parieslateral is in 4 cases, and interior wall in 1 case. The left ventricular ejection fraction was 36.52%± 12.15%, and left ventricular diastol ic final diameter was (62.30 ± 6.52 ) mm. Nine patients received standard l inear repair, 6 patients received standard l inear repair after endocardial ring shrinkage, and 8 patients received patch suture after endocardial ring shinkage. Results Two cases died perioperatively, and re-thoracotomy was performed to stop bleeding in 1 case. Incisions healed by first intention in the other patients without early compl ication. Twentyone patients were followed up 7-48 months (median, 19 months). At 6 months after surgery, the left ventricular ejection fraction 46.52% ± 9.41% were significanly improved when compared with that at preoperation (t=2.240, P=0.023); the left ventricular diastol ic final diameter (52.23 ± 5.11) mm were significantly decreased when compared with that at preoperation (t=2.170, P=0.035). The cardiac function according to NYHA criteria was at grade I in 8 cases and at grade II in 13 cases. One patient died of cerebral hemorrhage at 18 months after operation and the activities of daily l iving recoverd in the others. Conclusion Individual theraputic methods are used according to patients’ different conditions for left ventricular aneurysm after myocardial infarction.
Objective To investigate the expression of c-met in tall cell variant of papillary thyroid carcinoma, and to compare it with other types of thyroid carcinoma and benign thyroid tissue. Methods The expressions of c-met in 60 cases of thyroid specimens were tested by immunohistochemical staining. Results The levels of expressed c-met in tall cell variant specimens were significantly higher than those in other types of papillary thyroid carcinoma and benign thyroid tissue. c-met expressions were significantly different in the following pairs of types: tall cell variant vs common papillary carcinoma of thyroid (P=0.000 1), tall cell variant vs follicular variant papillary thyroid carcinoma (P=0.000 1), and tall cell variant vs benign thyroid tissue (P=0.000 1). In addition, for all types of papillary carcinomas evaluated, c-met expression was significantly higher in specimens with extracapsular spread (P=0.010 0) and skeletal muscle invasion (P=0.020 0). Conclusion The high expression of c-met is a significant marker for tall cell variant papillary carcinoma of thyroid and its invasive behavior. This finding may explain the unusually aggressive behavior of this tumor and suggest a role for c-met in the early identification of patients with tall cell variant thyroid carcinoma.
Objective To evaluate the mid-long term results of application research of artificial Gore-Tex chordate in mitral valvuloplasty in patients with mitral insufficiency caused by endocarditis. Methods We retrospectively analyzed the clinical data of 28 consecutive infective endocarditis(IE) patients who received mitral valve repair with Gore-Tex in our hospital between January 2012 and December 2015. There were 17 males and 11 females. The age of these patients ranged from 18 to 69 (52.0±15.4) years. Echocardiography before operation showed the degree of mitral regurgitation (MR) was severe in 19 patients, moderate in 9 patients. Six patients were in New York Heart Association (NYHA) class Ⅱ, 14 in class Ⅲ, 8 in class Ⅳ. There were 26 selective surgeries and 2 emergent surgeries. One patient had concomitant coronary artery bypass graft. Six patients had aortic valve replacement. Five patients had aortic valve repair. Twenty patients had tricuspid valve repair. Five patients had Maze procedure. Results Follow-up was done to all the patients for 6 months to 55 (30.5±6.4) months. During the follow-up, the echocardiography showed that postoperative left atrium diameter (36.64±8.50 mm vs. 51.78±17.50 mm, P<0.05) and left ventricular end-diastolic dimension (49.30±5.05 mmvs. 57.70±7.49 mm, P<0.05) were significantly smaller than those before operation. The left ventricular ejection fraction (EF) increased from 53.86%±8.16% to 59.14%±4.23% (P<0.05). No MR was found in 16 patients, mild MR in 8 patients, mild to moderate MR in 2 patients, moderate MR in 1 patient. One patient required reoperation for recurrent infection. No death or complications related to thrombosis and embolism occurred after operation. Conclusion Application research of artificial Gore-Tex chordate in mitral valve repair is feasible for treating mitral valve lesions caused by endocarditis, and may provide a long-term outcome to the patients.
Objective To investigate the effects of antiepileptic drugs (AEDs) with warfarin functions and blood coagulation system, to provide the reference for clinicians of the selection of AEDs under the combination therapy with warfarin. Methods Analyse the clinical data of the patient with symptomatic epilepsy from the Second Clinical Medical College of Guiyang University of Chinese Medicine on April 1, 2017, whom taking AEDs and warfarin at the same time, clear the drug adverse reactions, and analysed related literature. Results After the treatment with valproate, abnormal blood coagulation, a danger and emergency data appeared, so we stopped using warfarin immediately, and reduce the dosage of valproate gradually, insteadly, we used levetiracetam as antiepileptic therapy. Monitoring blood coagulation function, when it returned to normal, restart warfarin anticoagulant therapy. Conclusions When start antiepileptic treatment in relevant basic diseases of symptomatic epilepsy, for a variety of combination reactions, AEDs can affect the anticoagulant effect of warfarin, so we need to consider the interaction between drugs and avoid adverse reactions.
ObjectiveTo systematically review the efficacy of mobile health (mHealth) apps on weight loss.MethodsWeb of Science, PubMed, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of mHealth APPs on weight loss from inception to October 18, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 12 RCTs involving 1 074 patients were included. The results of meta-analysis showed that the apps group was superior to the control group in body weight (MD=−1.88, 95%CI −3.23 to −0.53, P=0.006). There was a decreasing trend of body mass index (BMI) in apps group (MD=−0.55, 95%CI −1.09 to 0.00, P=0.05).ConclusionsCurrent evidence shows that mHealth app can increase the efficacy of weight loss. Due to limited quality and quantity of the included studies, more highquality studies are required to verify above conclusions.
Objective To investigate the mechanism of gastrointestinal motility disorder of severe acute pancreatitis （SAP） in rats. Methods SD rats were randomly divided into 2 groups：sham operation （SO） group （n=16） and SAP group （n=16）. The gastric antrum interdigestive myoelectric complex （IMC） of rat was recorded by using bipolar silver electrode recording， the concentration of serum motilin （MTL） and vasoactive intestinal peptide （VIP） were detected by enzyme-linked immunosorbent assay （ELISA） method， and determined the pancreatic pathology score. Results Compared with SO group， the concentration of serum MTL obvious decreased and the concentration of VIP obvious rised in SAP group （P＜0.01）. Compared with SO group， the time of IMC cycle， andⅠand Ⅱ phase were extended， and time of Ⅲ phase was shortened， also the amplitude and frequency of peak electric of Ⅲ phase were declined in SAP group （P＜0.01）. And the concentration of MTL in SAP group showed positive correlation with the time of Ⅲ phase of IMC （r=0.967， P＜0.01）， the concentration of VIP in SAP group showed negative correlation with the time of Ⅲ phase of IMC （r=-0.592， P＜0.05）. The pancreatic organization pathological score in SAP group was higher than that in SO group （P＜0.01）. Conclusion There is gastrointestinal motility disorder in SAP rats， furthermore， it may induce gastrointestinal motility disorder through effecting the gastrointestinal smooth muscle electrical activity.