Drug-eluting stents have great impact to the coronary artery bypass grafting(CABG) in cardiac surgery. Someone even believes that it could replace the surgery procedure. However, the drug-eluting stents are not so ideally in the clinic practice. There are no significant difference between drug-eluting stents and bare metal stents in the mortality and the angina recurrence in middle-long term follow-up. The same results are in the compare with the CABG. As the challenge of the drug-eluting stents, the cardiac surgery has many aspects practice and progress in the harvest of the bypass graft. In the article, the change of the CABG conduit in the era of drug-eluting stents are reviewed.
Krüppel-like factor 4 (KLF4) is a member of the sample Kruppel transcription factor protein family, is an evolutionary conservative contain zinc finger transcription factors, involved in regulating many cellular processes, such as cell growth, proliferation, differentiation and invasion, KLF4 expression in a variety of tissues and cells in the body, has widely in many physiological and pathological conditions. Many studies have shown that KLF4 is involved in neurobiological processes such as neuroinflammation, oxidative stress, apoptosis and axon regeneration, and is closely related to a variety of nervous system diseases such as epilepsy, stroke, and Alzheimer’s disease. Now KLF4 in its role in the development of nervous system diseases were reviewed, help to understand the pathogenesis of the disease and clinical treatment for diseases of the nervous system to provide potential targets.
ObjectiveTo evaluate the risk factors for incidental durotomy (ID) during lumbar surgery. MethodsEighty-six patients with ID and 86 patients with no ID (who were matched 1∶1 in surgeons and surgery time) were selected from 2 235 patients who underwent lumbar surgery between January 2010 and December 2012. The gender, age, body mass index, history of smoking, alcoholism, nonsteroidal drug use, the etiology, lumbar surgery history, revision surgery, surgical approach, osteoporosis, diabetes, and surgical procedure were compared between 2 groups. Logistic regression analysis was applied to analyze the risk factors for ID. ResultsThere was significant difference (P<0.05) in etiology, surgical approach, revision surgery, lumbar surgery history, and surgical procedure between patients with ID and patients with no ID, which were then included in multivariate analysis. Logistic regression analysis demonstrated that lumbar surgery history, revision surgery, and minimal invasive surgery were risk factors for ID during lumbar surgery (P<0.05). ConclusionLumbar surgery history, revision surgery, and minimal invasive surgery were risk factors for ID during lumbar surgery, thus surgery for patients with the above histories should be carefully performed to prevent ID.
ObjectiveTo analyze the clinical characteristics, risk factors, treatment and prognosis of epilepsy secondary to cerebral infarction.MethodsThe clinical data of 109 patients with epilepsy secondary to cerebral infarction admitted to the Affiliated Central Hospital of Shandong First Medical University from October 2018 to February 2021 were retrospectively analyzed, including the location of cerebral infarction, seizure type, seizure time and antiepileptic treatment.Results3 426 patients with cerebral infarction were treated in the same period, and the incidence of epilepsy secondary to cerebral infarction was 3.18%. Among 109 patients with epilepsy secondary to cerebral infarction, 71 were male and 38 were female, the average age was (67.42 ± 28.58) years. Time of seizure after cerebral infarction: 67 cases (61.47%) were early onset epilepsy and 42 cases (42.47%) were late onset epilepsy. The infarct site: 63.30% (69 /109) in cortex, 11.93% (13/109) in subcortical area, and 24.77% (27/109) in lacunar infarction secondary epilepsy. 5 cases died, the fatality rate was 1.59%, of which 4 patients died of early onset epilepsy, status epilepticus, and 1 patient died of late onset epilepsy due to acute cerebral infarction.ConclusionsIn patients with epilepsy secondary to cerebral infarction, the cortex is the most common site of infarction; focal seizures are more than comprehensive seizures; status epilepticus often indicates poor prognosis, so timely antiepileptic treatment should be given to improve the prognosis.
Objective To compare the sequential efficacy of high-flow nasal cannula oxygen therapy (HFNC) with non-invasive mechanical ventilation (NIV). Methods Randomized controlled trials comparing the efficacy of NIV sequential invasive mechanical ventilation with HFNC were included in the Chinese Journal Full-text Database, VIP Journal database, Wanfang Database, Chinese Biomedical Literature Database, PubMed, Cochrane Library and Embase. Meta-analysis was performed using RevMan5.4 software. Results A total of 2404 subjects were included in 19 studies. Meta-analysis results showed that compared with NIV, HFNC had a statistically significant difference in reducing patients' re-intubation rate in invasive mechanical ventilation sequence [relative risk (RR)=0.65, 95% confidence interval (CI) 0.50 - 0.86, Z=3.10, P=0.002]. HFNC showed statistically significant difference compared with NIV in reducing lung infection rate (RR=0.40, 95%CI 0.21 - 0.79, Z=2.67, P=0.008). HFNC was significantly different from NIV in terms of length of stay in Intensive Care Unit (ICU) (MD=–5.77, 95%CI –7.64 - –3.90, Z=6.05, P<0.00001). HFNC was significantly different from NIV in improving 24 h oxygenation index (MD=13.16, 95%CI 8.77 - 17.55, Z=5.87, P<0.00001). There was no significant difference in ICU mortality between HFNC and NIV (RR=0.70, 95%CI 0.45 - 1.08, Z=1.61, P=0.11). Conclusion Compared with NIV, sequential application of HFNC in invasive mechanical ventilation can improve the reintubation rate and pulmonary infection rate to a certain extent, reduce the length of ICU stay and improve the 24 h oxygenation index, while there is no difference in ICU mortality, which is worthy of clinical application.
Objective To study the preparation method of acellular vascular matrix and to evaluate its biocompatibil ity and safety so as to afford an ideal scaffold for tissue engineered blood vessel. Methods Fresh caprine carotids (length, 50 mm) were harvested and treated with repeated frozen (—80 )/thawing (37℃), cold isostatic pressing (506 MPa, 4 ), and 0.125% sodium dodecyl sulfate separately for preparation of acellular vascular matrix. Fluorescence staining and DNA remain test were used to assess the cell extracting results. Biological characteristics were compared with the raw caprine carotids using HE staining, Masson staining, scanning electron microscope (SEM), and mechanical test. Biocompatibil ity wasdetected using cell adhesion test, MTT assay, and subcutaneously embedding test. Ten SD rats were divided into 2 groups (n=5). In experimental group, acellular vascular matrix preserved by the combination of repeated frozen/thawing, ultrahigh pressure treatment and chemical detergent was subcutaneously embedded; and in control group, acellular vascular matrix preserved only by repeated frozen/thawing and ultrahigh pressure treatment was subcutaneously embedded. Results HE staining and Masson staining revealed that no nucleus was detected in the acellular vascular matrix. SEM demonstrated that a lot of collagen fibers were preserved which were beneficial for cell adhesion. Fluorescence staining and DNA remain test showed that the cells were removed completely. There was no significant difference in stress and strain under the maximum load between before and after treatment. Mechanical test revealed that the acellular vascular matrix reserved mechanical properties of the raw caprine carotids. Cell adhesion test and MTT assay confirmed that cytotoxicity was grade 0-1, and the acellular vascular matrix had good compatibil ity to endothel ial cells. After subcutaneously embedding for 8 weeks, negl igible lymphocyte infiltration was observed in experimental group but obvious lymphocyte infiltration in control group. Conclusion The acellular vascular matrix, which is well-preserved by the combination of repeated frozen/thawing, ultrahigh pressure treatment, and chemical detergent, is an ideal scaffold for tissue engineered blood vessel.
ObjectiveTo analyze the clinical characteristics and related prognostic factors of post-renal transplantation pneumonia.MethodsThe clinical data of 89 patients with post-renal transplantation pneumonia in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital from 1st January 2014 to 31st December 2015 were collected in the study. Kaplan-Meier method was used to calculate overall survival. Cox analysis was used to analyze the related prognostic factors.ResultsPost-renal transplantation pneumonia occurred mainly within 6 months after renal transplantation. The prominent clinical manifestations were cough (95.5%), fever (56.1%), and dyspnea (12.3%). The mortality of post-renal transplantation pneumonia was 11.2% and all death occurred within 5 months after transplantation. The overall survival rate significantly decreased in the patients with C-reactive protein (CRP) ≥40 mg/L (P<0.001), procalcitonin ≥1 ng/ml (P=0.002), brain natriuretic peptide >100 pg/ml (P<0.001), platelet ≤100×109/L (P<0.001), or those with occurrence time of pneumonia <180 days (P=0.013). Platelet ≤100×109/L could increase the risk of death by 66.6 times (RR=0.015, P=0.006), and CRP ≥ 40 mg/L could increase the risk of death by 20 times (RR=0.05, P=0.029).ConclusionsPost-renal transplantation pneumonia has prominent clinical characteristics. Platelet ≤100×109/L or CRP ≥40 mg/L can increase the risk of death and can be used as an independent prognoctic factor of post-renal transplatation pneumonia.