Objective To review the status and appl ication prospect in repair of spinal cord injury by stem cells. Methods The related articles in recent years were extensively reviewed, the biological characteristics of stem cells, the experimental and cl inical studies on repair of spinal cord injury by stem cells, the mechanism of the therapy and the problem were discussed and analyzed. Results The foundational and cl inical study indicated that the great advance was made in repair of spinal cord injury, the stem cells could immigrate in the spinal cord, and differentiate into neuron and secrete neurotrophic factors. So it could promote the repair effects. Conclusion Repair of spinal cord injury by stem cells is an effective therapystrategy, but many problems remain to be resolved.
【摘要】 目的 分析合并免疫指标异常的视神经脊髓炎临床特点。 方法 回顾性分析2009年5月-2010年11月收治的62例视神经脊髓炎患者中24例合并免疫指标异常患者的临床资料。24例均为女性，发病年龄14~53岁。对其临床表现、视觉诱发电位、影像学检查结果、免疫检查结果进行分析。 结果 所有患者均有脊髓和视神经同时或先后受累的表现。24例视觉诱发电位检查23例异常。脊髓MRI显示病变集中于颈段、上胸段脊髓。颈段和胸段脊髓同时受累17例，单纯颈段脊髓受损6例，单纯胸段脊髓受损1例。所有患者抗核抗体滴度均≥1∶100，合并抗SSA抗体阳性14例（55.5％），同时合并抗SSB抗体阳性11例（45.8％），合并抗Rib抗体阳性1例，合并抗SCL-70抗体阳性1例，合并抗dsDNA抗体1例。 结论 视神经脊髓炎合并免疫指标异常的患者以女性较为多见，易复发，青壮年患者发病率最高。脊髓MRI示病变集中于颈段、上胸段脊髓，表现为长节段脊髓损害。视神经脊髓炎患者合并结缔组织病的病例较多。【Abstract】 Objective To analyze the clinical features of neuromyelitis optica (NMO) combined with abnormal immune parameters. Methods We retrospectively reviewed the clinical data of 24 patients with NMO and abnormal immune parameters among the 62 NMO patients who were admitted into our department between May 2009 and November 2010. All patients were female, aged from 14 to 53 years. We analyzed their clinical manifestations, visual evoked potentials, imaging results, and immunological examinations. Results All patients had simultaneous or successive spinal cord and optic nerve involvement. Twenty-three patients had abnormal visual evoked potential. MRI showed that the lesions focused on the cervical and upper thoracic spinal cord. Both cervical and thoracic spinal cord were involved in 17 cases; there were 6 cases of simple cervical spinal cord injury and 1 case of simple thoracic spinal cord damage. Antinuclear antibody titer of all the patients was ≥1∶100. Combined positive anti-SSA antibody occurred in 14 patients (55.5%); Concomitant positive anti-SSB antibodies occurred in 11 patients (45.8%); Combined positive anti-Rib antibodies occurred in 1 patient; Combined positive anti-SCL-70 antibody occurred in 1 patient; and combined positive anti-dsDNA antibodies occurred in 1 patient. Conclusions NMO combined with abnormal immune parameters mainly occurs in female patients, especially in young people. Recurrence rate is high. MRI shows that the lesions focus mainly on the cervical and upper thoracic spinal cord, manifesting the characteristic of long segment damage. And NMO is frequently combined with connective tissue disease.
Objective To explore the clinical features and prognosis related factors of severe drug eruption. Methods The clinical data of 48 patients with drug eruption treated between January 2010 and August 2015 were retrospectively analyzed. Results The major type of drug eruption was Stevens-Johnson syndrome (58.3%), followed by toxic epidermal necrolysis (TEN) (27.1%) and hypersensitivity syndrome (14.6%). The major allergenic drug which might cuase drug eruption was antimicrobial agent (25.0%), followed by antipyretic analgesic drug (22.9%) and antigout drug (18.8%). Carbamazepine and allopurino were the common drugs caused TEN. Conclusion It is important to give sufficient corticosteroid earlier combined with intravenous immunoglobulin for reducing mortalities of severe drug eruption.
Objectives To investigate the risk factors, clinical features, and clinical outcomes of severe cerebral infarction (SCI), and explore the association between different risk factors and outcomes in SCI. Methods We prospectively registered consecutive cases of acute ischemic stroke at the neurological wards of West China Hospital, Sichuan University from January 1st, 2008 to May 27th, 2013. Patients with ischemic stroke within 30 days of symptom onset were included. SCI was defined as the score of National Institutes of Health Stroke Scale greater than 15. Data were collected on clinical and biological variables, risk factors for stroke and the presence of comorbidities. The data management and analysis were performed with the SPSS 16.0 package. Univariate and multivariate analysis were used to analyze the predictors of SCI and its outcomes. Results Of the 3 364 enrolled cases, 348 (10.3%) were SCI. Compared with non-SCI (NSCI), SCI patients were older, with a lower proportion of males, higher NIHSS scores, lower Glasgow Coma Scale (GCS) scores, and higher proportions of previous heart disease history and previous stroke history, and lower hemoglobin levels on admission. SCI group had a greater proportion of large-artery atherosclerosis (LAA) and cardioembolism (CE) and less proportion of small artery occlusive infarction. After adjustment for the confounders, age [odds ratio (OR)=1.020, 95% confidence interval (CI) (1.010, 1.031), P<0.001], LAA [OR=1.442, 95%CI (1.062, 1.958), P=0.019], and CE [OR=1.919, 95%CI (1.319, 2.793), P=0.001] were independently associated with SCI. The case fatality and case fatality or disability with SCI were 32.1% and 83.3% at the end of 3 months, and 41.8% and 79.3% at the end of 1 year. Among different types, patients with undetermined type had the highest mortality rate, with patients with LAA being the lowest (P≤0.001). There was no significant association between TOAST type and the rate of fatality or disability. Multiple factor analysis showed that the most important independent predictive factor of prognosis was age. Meanwhile, sex and previous stroke history were also the independent predictive factors for death at the 3rd month. Hyperlipidemia, valvular heart disease, and GCS score on admission were independent predictive factors for death/disability at the 3rd month. Conclusions Our study indicates that patients with SCI accounted for 10.3% of acute ischemic stroke. The case fatality or disability in SCI patients are higher than those in NSCI patients. The old age, LAA and CE are independent predictive factors of SCI. Age is the most important prognostic factor of patients with SCI.
With the development of photothermal nanomaterials, photothermal therapy based on near-infrared light excitation shows great potential for the bacterial infected wound treatment. At the same time, in order to improve the photothermal antibacterial effect of wound infection and reduce the damage of high temperature and heat to healthy tissue, the targeted bacteria strategy has been gradually applied in wound photothermal therapy. In this paper, several commonly used photothermal nanomaterials as well as their targeted bacterial strategies were introduced, and then their applications in photothermal antibacterial therapy, especially in bacterial infected wounds were described. Besides, the challenges of targeted photothermal antibacterial therapy in the wound healing application were analyzed, and the development of photothermal materials with targeted antibacterial property has prospected in order to provide a new idea for wound photothermal therapy.
Objective To understand the dynamic changes of inflammatory indicators in the peripheral blood of patients with malignant cerebral edema at different time points after acute cerebral infarction, and provide a basis for early prediction and prevention of malignant cerebral edema. Methods Consecutive patients with acute cerebral infarction within 24 h of onset who were admitted to the Department of Neurology, West China Hospital of Sichuan University between January 1st, 2017 to December 31st, 2018 were collected. The basic clinical data of the patients were collected, and the data of inflammatory cells (white blood cell count, absolute neutrophil count, absolute lymphocyte count, and neutrophil to lymphocyte ratio) and acute phase reactants (blood glucose, fibrinogen, albumin, and fibrinogen to albumin ratio) were dynamically collected at admission and 1, 3, and 7 d after admission, respectively. Differences between groups were compared using generalized estimating equations. Results A total of 798 patients with acute cerebral infarction were included, of whom 93 (11.65%) developed malignant cerebral edema. At all time points examined, the white blood cell counts, absolute neutrophil counts, and neutrophil to lymphocyte ratios were higher in the malignant cerebral edema group than those in the non-malignant cerebral edema group (Wald χ2=63.737, P<0.001; Wald χ2=91.848, P<0.001; Wald χ2=75.197, P<0.001); 1 and 3 d after admission, the absolute lymphocyte counts were lower in the malignant cerebral edema group than those in the non-malignant cerebral edema group (Wald χ2=18.580, P<0.001). The blood glucose levels were higher in the malignant cerebral edema group compared with the non-malignant cerebral edema group 1, 3, and 7 d after admission (Wald χ2=16.722, P<0.001); no significant between-group effect was found in the albumin levels (Wald χ2=3.643, P=0.056); the fibrinogen levels were significantly different between groups 3 d after admission (Wald χ2=8.923, P=0.003), and the fibrinogen to albumin ratios differed between the two groups 3 and 7 d after admission (Wald χ2=6.739, P=0.009). Dynamic analysis of multiple time points in the malignant cerebral edema group found that these inflammatory markers mostly reached their extreme values 3 d after admission. Conclusions Compared with the non-malignant cerebral edema group, the inflammatory cell-related indicators (except lymphocytes) and the acute phase inflammatory reactant-related indicators in malignant cerebral edema patients are significantly higher, and the absolute lymphocyte count is significantly lower. Three days after admission to hospital is probably the most significant time point for the change of each inflammatory indicator.
Objective To explore the association between C-reactive protein (CRP) change and the prognosis of patients with stroke. Methods Individuals who were diagnosed with stroke from the 2011 China Health and Retirement Longitudinal Study (CHARLS) registry were included. The baseline characteristics in 2011, blood tests in 2011 and 2015, and follow-up data in 2018 were collected. The patients were divided into three groups according to their CPR change from 2011 to 2015, and the cut-off values of CRP change were 0 and 5 mg/L. Logistic regression analysis was performed to evaluate the association between CRP change and the risk of death after stroke. Results A total of 1065 participants diagnosed in 2011 were enrolled. There were 383 participants in the CRP decreased group (CRP change ranging from –74.30 to –0.01 mg/L), 584 participants in the CRP stable group (CRP change ranging from 0 to 4.98 mg/L), and 98 participants in the CRP increased group (CRP change ranging from 5.00 to 79.27 mg/L). By 2018, the numbers (rates) of deaths in CRP decreased group, CRP stable group, and CRP increased group were 25 (6.53%), 33 (5.65%), and 13 (13.27%), respectively, and the difference in the mortality among the three groups was statistically significant (P=0.020). Logistic regression analysis showed that the CRP change≥5 mg/L was associated with a higher risk of death after stroke [odds ratio=2.332, 95% confidence interval (1.099, 4.946), P=0.027]. Conclusions Increasing CRP levels over time may indicate an increased risk of death in stroke patients. A 4-year increase in CRP greater than 5 mg/L may be an independent predictor of the risk of long-term death in stroke patients.
Objective To explore the association between triglyceride glucose-waist circumference (TyG-WC) index and the risk of stroke among the middle-aged and older people, and compare the differences among TyG-WC, triglyceride glucose (TyG), and waist circumference (WC) in the prediction of stroke. Methods The data of adults aged 45 years or older enrolled in the China Health and Retirement Longitudinal Study registry in 2011 were collected, and the endpoint was self-reported or physician-diagnosed new stroke event by 2015. According to the baseline TyG-WC tertile, individuals were divided into three groups: TyG-WC tertile 1, tertile 2, and tertile 3 groups. Multiple logistic regression analyses were performed to analyze the associations of TyG-WC, TyG, and WC with the risk of stroke. The area under the curve (AUC) of receiver operating characteristic (ROC) curve, integrated discrimination improvement (IDI) score, and net reclassification improvement (NRI) score were calculated to evaluate the predictive value of TyG-WC, TyG, and WC in stroke. Results A total of 5847 participants were finally included, with 1949 in each group. After 4 years of follow-up, there were 252 cases of new stroke. There was significant difference in the incidence of stroke among the three groups (TyG-WC tertile 1 group: 2.57%, TyG-WC tertile 2 group: 4.16%, TyG-WC tertile 3 group: 6.21%; P<0.05). The results of multiple logistic regression analyses showed that the risk of new stroke in the third tertile group of TyG-WC and WC was higher than that in the first tertile group, respectively [TyG-WC: odds ratio (OR)=1.465, 95% confidence interval (CI) (1.033, 2.078), P=0.032; WC: OR=1.717, 95%CI (1.190, 2.478), P=0.004], while TyG was not the risk factor of stroke (P>0.05). The ROC curve analysis showed that the AUC of WC (0.566) was slightly higher than that of TyG-WC (0.556) and TyG (0.527). The IDI of TyG-WC (0.25%) was slightly higher than that of WC (0.22%), and the both were higher than that of TyG (0.07%). The NRI of WC (25.04%) was slightly higher than that of TyG-WC (19.68%), and the both were high than that of TyG (12.02%). Conclusions Compared with TyG, higher TyG-WC and WC are associated with the increased risk of new stroke among the middle-aged and older people. The predictive value of TyG-WC and WC for the risk of new stroke in the middle-aged and elderly is similar, and is better than that of TyG.
Objective To explore the association between procalcitonin (PCT) level and the development of malignant brain edema (MBE) after acute cerebral infarction. Methods The data on patients with stroke admitted to the Department of Neurology of West China Hospital, Sichuan University between January 1, 2017 and December 31, 2018 were retrospective collected. Patients were divided into MBE group and non-MBE group based on whether MBE had occurred. The basic information and neuroimaging data of two groups of patients were compared and analyzed. Results A total of 798 patients were included. Among them, there were 93 cases of MBE (11.65%) and 705 cases of non-MBE (88.35%). The median time of MBE occurrence (lower quartile, upper quartile) was 29 (24, 54) hours after onset. The difference in the National Institutes of Health Stroke Scale, large-scale middle cerebral artery infarction, dysarthria, low fever, consciousness status, chronic heart failure, TOAST typing, mechanical ventilation, gastric tube placement, PCT on the first and third day of admission between the two groups were statistically significant (P<0.05). There was no statistically significant difference in the other indicators between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that both day 1 PCT and large-scale middle cerebral artery infarction were associated with MBE. Conclusions Elevated PCT within 24 hours from onset is independently associated with the development of MBE after acute cerebral infarction. Patients with elevated PCT after cerebral infarction may require careful clinical management.
Objective To construct and verify the diagnostic model of preoperative malignant risk of ovarian tumors, so as to improve the diagnostic efficiency of existing test indexes. Methods The related serological indicators and clinical data of patients with ovarian tumors confirmed by pathology who were treated in the Affiliated Hospital of Southwest Medical University between January 2019 and September 2023 were retrospectively collected, and the patients were randomly divided into a training set and a verification set at a 7∶3 ratio. Logistic regression was used to construct a diagnostic model in the training set, and the diagnostic efficacy of the model was verified through discrimination, calibration, clinical benefit, and clinical applicability evaluation. Results A total of 929 patients with ovarian tumors were included, including 318 cases of malignant ovarian tumors and 611 cases of benign ovarian tumors. The patients were randomly divided into a training set of 658 cases and a validation set of 271 cases. A diagnostic model was constructed using logistic regression in the training set, containing 5 factors namely age, percentage of neutrophil (NEU%), fibrinogen to albumin ratio (FAR), carbohydrate antigen 125 (CA125), and human epididymis protein 4 (HE4): modelUAM=−3.211+0.667×age+2.966×CA125+0.792×FAR+1.637×HE4+0.533×NEU%, with a Hosmer-Lemeshow test P-value of 0.21. The area under the receiver operating characteristic (ROC) curve measured in the training set was 0.927 [95% confidence interval (0.903, 0.951)], the sensitivity was 0.947, and the specificity was 0.780. The area under the ROC curve of the validation set was 0.888 [95% confidence interval (0.840, 0.930)], the sensitivity was 0.744, and the specificity was 0.901. Conclusion A new quantitative tool based on age, NEU%, FAR, CA125 and HE4 can be used for the clinical diagnosis of ovarian malignant tumors, and it is helpful to improve the diagnostic efficiency and is worth popularizing.