ObjectiveTo explore the risk factors for 24-hour death in acute type A aortic dissection (ATAAD) patients with conservative treatment.MethodsFrom January 2009 to January 2018, 243 ATAAD patients who received non-surgical intervention were admitted in Beijing Anzhen Hospital, including 167 males and 76 females with an average age of 53.0±12.0 years. The risk factors for 24-hour mortality were analyzed.ResultsThe total in-hospital mortality rate was 37.9% (93/243), and 13.6% (33/243) patients died within 24 hours of onset. We found that left ventricular end diastolic diameter [LVEDD, OR=0.45, 95%CI (0.25, 0.83), P<0.01] and aortic regurgitation [OR=7.26, 95%CI (1.67, 31.53), P<0.01] were independent risk factors for 24-hour death in patients with ATAAD.ConclusionIn this study, LVEDD and aortic regurgitation are identified as independent risk factors for 24-hour mortality in ATAAD patients. Therefore, patients with aortic regurgitation and small LVEDD should be treated with sugery as soon as possible.
ObjectiveTo summarize the current research progress of serum exosome microRNAs in patients with colorectal cancer.MethodsThe domestic and foreign literatures related to serum exosome microRNAs of colorectal cancer patients, which had been reported in recent years were collected through literature search. Subsequently, those literatures were used to read and review.ResultsExosomes were extracellular vesicles, which contained lipids, proteins, DNA, RNA (mRNA, microRNA, and long non-coding RNA), and other molecules. These vesicles mediated communication between cells by transporting the above molecules. Exosomes in serum were the main carriers of microRNAs in the blood circulation system. Serum exosome microRNAs could affect the proliferation, invasion, and metastasis of colorectal cancer cells, mediate the drug resistance of colorectal cancer cells, and could be used as biomarkers to predict the prognosis of colorectal cancer.ConclusionsSerum exosome microRNAs play important role in the occurrence, development, treatment, and diagnosis of colorectal cancer. As a class of biomarker, serum exosome microRNAs have great potential in the early diagnosis and prognostic evaluation of colorectal cancer.
Objective To summarize the best evidence for prevention of deep vein thrombosis (DVT) in lower limbs of patients with spinal cord injury (SCI), and provide a basis for medical staff to develop evidence-based prevention and management measures for DVT in the lower limbs of patients with SCI. Methods UpToDate, BMJ Best Practice, Guidelines International Network, National Institute for Health and Clinical Excellence, Registered Nurses’ Association of Ontario, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, New Zealand Guidelines Group, JBI evidence-based healthcare center database, Web of Science, Embase, Cochrane Library, CINAHL, Medlive, China guidelines network, SinoMed, China National Knowledge Infrastructure, and Wanfang were systematically searched. Evidence related to the prevention of DVT in lower limbs of patients with SCI has been collected. The search period was from January 1, 2019 to June 30, 2024, and the literature was screened, quality evaluated, evidence extracted, and summarized. Results Finally, 22 articles were included, including 3 guidelines, 2 clinical decision-making articles, 4 best practices articles, 7 evidence summaries, 4 expert consensus articles, and 2 systematic reviews. A total of 32 pieces of evidence were ultimately formed in six aspects of risk assessment, diagnosis and screening, prevention principle, drug prevention, mechanical prevention, and health education. Conclusions There is a lot of evidence involved in the prevention of DVT in lower limbs of patients with SCI. In the clinical implementation process, medical staff can carefully choose prevention plans based on the patients’ clinical condition to reduce the incidence of DVT in patients with SCI during hospitalization.
Objective To investigate the surgery tactics for ossification of ligamentum flavum (OLF) associated with dural ossification (DO) in the thoracic spine and the cl inical outcome. Methods Between June 2006 and December 2009, 98 patients with thoracic spinal stenosis secondary to OLF were treated, and DO was found in 18 cases during operation. There were 11 males and 7 females with a mean age of 58 years (range, 46-73 years). The disease duration ranged from 5 to 48 months (mean,20 months). All patients underwent surgical decompression because of recent neurological aggravation. Both DO and OLF were resected with octagonal decompression by dissecting pedicle flavum tunnel. The Japanese Orthopaedic Association (JOA) score, modified Oswestry Disabil ity Index (ODI), and the Cobb angle were used to evaluate the effectiveness. Results The initial symptoms were significantly alleviated postoperatively. All patients had transient cerebrospinal fluid (CSF) leakage postoperatively, the CSF leakage disappeared after 8-10 days of conservative treatment. All the incisions healed by first intention. There was no complication of neurologic function deterioration, meningitis, wound infection, or spinocutaneous fistula. Eighteen patients were followed up 20-60 months (mean, 49 months). No recurrence of spinal cord compression symptoms,or neurologic function deterioration was observed at last follow-up. The JOA scores and effectiveness and modified ODI scores were significantly improved after 1 month and 12 months of operation when compared with preoperative scores (P lt; 0.05). The Cobb angles of kyphosis of the involved vertebrae were (6.7 ± 1.6)° before operation and (8.0 ± 1.2)° after 12 months of operation, showing significant difference (t=4.000，P=0.001). Postoperative T2-weighted axial MRI, sagittal MRI scan, and short T1 inversion recovery MRI showed that compressed deformity of the spinal cord returned to normal. Conclusion The surgery tactics for thoracic spinal stenosis secondary to the OLF with DO is safe, and no patching dura mater tears is effective.