Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations.However,the ability of retinal vasculature changes,specifically focusing on retinal vessel diameter,t...Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations.However,the ability of retinal vasculature changes,specifically focusing on retinal vessel diameter,to predict the recurrence of cerebrovascular events in patients with ischemic stroke has not been determined comprehensively.While previous studies have shown a link between retinal vessel diameter and recurrent cerebrovascular events,they have not incorporated this information into a predictive model.Therefore,this study aimed to investigate the relationship between retinal vessel diameter and subsequent cerebrovascular events in patients with acute ischemic stroke.Additionally,we sought to establish a predictive model by combining retinal veessel diameter with traditional risk factors.We performed a prospective observational study of 141 patients with acute ischemic stroke who were admitted to the First Affiliated Hospital of Jinan University.All of these patients underwent digital retinal imaging within 72 hours of admission and were followed up for 3 years.We found that,after adjusting for related risk factors,patients with acute ischemic stroke with mean arteriolar diameter within 0.5-1.0 disc diameters of the disc margin(MAD_(0.5-1.0DD))of≥74.14μm and mean venular diameter within 0.5-1.0 disc diameters of the disc margin(MVD_(0.5-1.0DD))of≥83.91μm tended to experience recurrent cerebrovascular events.We established three multivariate Cox proportional hazard regression models:model 1 included traditional risk factors,model 2 added MAD_(0.5-1.0DD)to model 1,and model 3 added MVD0.5-1.0DD to model 1.Model 3 had the greatest potential to predict subsequent cerebrovascular events,followed by model 2,and finally model 1.These findings indicate that combining retinal venular or arteriolar diameter with traditional risk factors could improve the prediction of recurrent cerebrovascular events in patients with acute ischemic stroke,and that retinal imaging could be a useful and non-invasive method for identifying high-risk patients who require closer monitoring and more aggressive management.展开更多
Diabetes mellitus(DM) is a major risk factor for cardiovascular events, including ischemic stroke. Moreover, ischemic stroke appears to be more severe in these patients and to be associated with less favorable outcome...Diabetes mellitus(DM) is a major risk factor for cardiovascular events, including ischemic stroke. Moreover, ischemic stroke appears to be more severe in these patients and to be associated with less favorable outcomes. However, strict glycemic control does not appear to reduce the risk of ischemic stroke. On the other hand, newer glucose-lowering agents(glucagon-like peptide 1 receptor agonists and sodiumglucose cotransporter 2 inhibitors) reduced the risk of cardiovascular events in recent randomized, placebocontrolled trials. Semaglutide also reduced the risk of ischemic stroke. These benefits are independent of glucose lowering and might be due to the favorable effects of these agents on body weight and blood pressure. Pioglitazone also reduced the risk of recurrent stroke in patients with insulin resistance or type 2 DM but the unfavorable safety profile limits its use. In contrast, sulfonylureas and dipeptidyl peptidase 4 inhibitors have a neutral effect on cardiovascular morbidity and might be less attractive options in this high-risk population.展开更多
BACKGROUND The outbreak of the coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2 has been the most important clinical challenge worldwide since January 2020.COVID-19 inact...BACKGROUND The outbreak of the coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2 has been the most important clinical challenge worldwide since January 2020.COVID-19 inactivated vaccines play a crucial role in reducing the rates of morbidity and mortality.CASE SUMMARY We presented a 48-year-old woman from Haidian District,Beijing,China who developed ischemic colitis after receiving the second dose of COVID-19 inactivated vaccine.Computed tomography of the abdomen showed edema and bowel wall thickening with hypodensity in the sigmoid colon and descending colon.Colonoscopy revealed hyperemia,edema and erosion of the mucosa with superficial ulceration and a yellow-white coating at the descending colon and sigmoid colon.The symptoms were relieved after 1 wk of receiving pinaverium bromide(50 mg,tid)and aspirin enteric-coated tablets(0.1 g,qd).CONCLUSION The possible occurrence of ischemic colitis should be considered after administration of the COVID-19 inactivated vaccines.展开更多
目的探讨脑小血管(cerebral small vessel disease,CSVD)负担评分对短暂性脑缺血发作(transient ischemic attack,TIA)患者复发性脑血管事件(recurrence cerebrovascular events,RCVEs)的预测价值。材料与方法回顾性分析2019年10月至202...目的探讨脑小血管(cerebral small vessel disease,CSVD)负担评分对短暂性脑缺血发作(transient ischemic attack,TIA)患者复发性脑血管事件(recurrence cerebrovascular events,RCVEs)的预测价值。材料与方法回顾性分析2019年10月至2022年12月期间于安徽省第二人民医院就诊的182例TIA患者病例资料,依据MRI检查计算CSVD总体负担评分,根据随访1个月内有无发生RCVEs分为RCVEs组(n=46)和未RCVEs组(n=136)。比较两组临床资料和CSVD总体负担评分,采用多因素logistic回归分析模型分析RCVEs的独立危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析CSVD影像特征得分及总负担评分对TIA患者RCVEs的预测价值。结果RCVEs组和未RCVEs组TIA发作次数、症状持续时间、既往高血压病史、CSVD总负担评分及分级情况比较差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示:TIA发作次数、症状持续时间、CSVD总负担评分是TIA患者发生RCVEs的独立危险因素(P<0.05)。ROC曲线分析结果显示:CSVD影像特征评分及总负担评分预测TIA患者发生RCVEs的曲线下面积(areas under the curve,AUC)分别为0.771(95%CI:0.673~0.869,P<0.001)、0.745(95%CI:0.655~0.835,P<0.001)、0.664(95%CI:0.549~0.780,P=0.009)、0.845(95%CI:0.766~0.924,P<0.001)、0.945(95%CI:0.896~0.994,P<0.001),其中CVSD总负担评分预测的AUC最高,当最佳截断值为2分时,敏感度为86.05%,特异度为83.02%。结论CSVD总负担评分对TIA患者发生RCVEs的预测价值良好,有助于临床评估TIA患者的短期预后。展开更多
目的:探讨主动强化风险干预联合抚触对新生儿缺氧缺血性脑病(Hypoxic-Ischemic encephalopathy,HIE)患儿风险事件及发育的影响。方法:选取2020年1月至2023年1月本院新生儿科收治的70例HIE患儿作为研究对象,根据随机数字表法分为对照组...目的:探讨主动强化风险干预联合抚触对新生儿缺氧缺血性脑病(Hypoxic-Ischemic encephalopathy,HIE)患儿风险事件及发育的影响。方法:选取2020年1月至2023年1月本院新生儿科收治的70例HIE患儿作为研究对象,根据随机数字表法分为对照组和研究组,各35例。对照组采用常规护理联合抚触干预,研究组实施主动强化风险干预联合抚触干预。分析比较两组风险事件,体格生长指标、精神运动及智力发育情况。结果:干预期间,研究组风险事件发生率明显低于对照组(P<0.05)。研究组身高、体重、头围增长值均明显高于对照组(P<0.05)。干预后,两组精神运动发育指数(Psychomotor development index,PDI)、智力发育指数(Mental development index,MDI)评分均较干预前升高,且研究组高于对照组(P<0.05)。结论:主动强化风险干预联合抚触能减少新生儿HIE护理风险事件的发生,还能促进患儿体格发育、改善精神运动及智力发育。展开更多
基金supported by the Youth Fund of Fundamental Research Fund for the Central Universities of Jinan University,No.11622303(to YZ).
文摘Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations.However,the ability of retinal vasculature changes,specifically focusing on retinal vessel diameter,to predict the recurrence of cerebrovascular events in patients with ischemic stroke has not been determined comprehensively.While previous studies have shown a link between retinal vessel diameter and recurrent cerebrovascular events,they have not incorporated this information into a predictive model.Therefore,this study aimed to investigate the relationship between retinal vessel diameter and subsequent cerebrovascular events in patients with acute ischemic stroke.Additionally,we sought to establish a predictive model by combining retinal veessel diameter with traditional risk factors.We performed a prospective observational study of 141 patients with acute ischemic stroke who were admitted to the First Affiliated Hospital of Jinan University.All of these patients underwent digital retinal imaging within 72 hours of admission and were followed up for 3 years.We found that,after adjusting for related risk factors,patients with acute ischemic stroke with mean arteriolar diameter within 0.5-1.0 disc diameters of the disc margin(MAD_(0.5-1.0DD))of≥74.14μm and mean venular diameter within 0.5-1.0 disc diameters of the disc margin(MVD_(0.5-1.0DD))of≥83.91μm tended to experience recurrent cerebrovascular events.We established three multivariate Cox proportional hazard regression models:model 1 included traditional risk factors,model 2 added MAD_(0.5-1.0DD)to model 1,and model 3 added MVD0.5-1.0DD to model 1.Model 3 had the greatest potential to predict subsequent cerebrovascular events,followed by model 2,and finally model 1.These findings indicate that combining retinal venular or arteriolar diameter with traditional risk factors could improve the prediction of recurrent cerebrovascular events in patients with acute ischemic stroke,and that retinal imaging could be a useful and non-invasive method for identifying high-risk patients who require closer monitoring and more aggressive management.
文摘Diabetes mellitus(DM) is a major risk factor for cardiovascular events, including ischemic stroke. Moreover, ischemic stroke appears to be more severe in these patients and to be associated with less favorable outcomes. However, strict glycemic control does not appear to reduce the risk of ischemic stroke. On the other hand, newer glucose-lowering agents(glucagon-like peptide 1 receptor agonists and sodiumglucose cotransporter 2 inhibitors) reduced the risk of cardiovascular events in recent randomized, placebocontrolled trials. Semaglutide also reduced the risk of ischemic stroke. These benefits are independent of glucose lowering and might be due to the favorable effects of these agents on body weight and blood pressure. Pioglitazone also reduced the risk of recurrent stroke in patients with insulin resistance or type 2 DM but the unfavorable safety profile limits its use. In contrast, sulfonylureas and dipeptidyl peptidase 4 inhibitors have a neutral effect on cardiovascular morbidity and might be less attractive options in this high-risk population.
文摘BACKGROUND The outbreak of the coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2 has been the most important clinical challenge worldwide since January 2020.COVID-19 inactivated vaccines play a crucial role in reducing the rates of morbidity and mortality.CASE SUMMARY We presented a 48-year-old woman from Haidian District,Beijing,China who developed ischemic colitis after receiving the second dose of COVID-19 inactivated vaccine.Computed tomography of the abdomen showed edema and bowel wall thickening with hypodensity in the sigmoid colon and descending colon.Colonoscopy revealed hyperemia,edema and erosion of the mucosa with superficial ulceration and a yellow-white coating at the descending colon and sigmoid colon.The symptoms were relieved after 1 wk of receiving pinaverium bromide(50 mg,tid)and aspirin enteric-coated tablets(0.1 g,qd).CONCLUSION The possible occurrence of ischemic colitis should be considered after administration of the COVID-19 inactivated vaccines.
文摘目的:探讨远端缺血预处理(remote ischemic preconditioning,RIPC)对髋部骨折老年患者术后1年发生心血管不良事件(major adverse cardiovascular events,MACEs)的影响。方法:2015年4月至2020年5月经手术治疗髋部骨折老年患者314例,男116例,女198例;年龄60-76岁;均为美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅱ-Ⅲ级。所有患者进行常规麻醉,根据是否进行RIPC将患者分为两组,157例在常规麻醉基础上应用RIPC为干预组,男56例,女101例,年龄(68.12±7.13)岁;另157例为对照组,男60例,女97例,年龄(68.24±7.05)岁。对比分析两组患者术后1年的MACEs事件。结果:应用RIPC髋部骨折患者术后1年发生心肌梗死、心力衰竭、脑卒中、非致命性心搏停止、冠状动脉血运重建术、严重心律失常、周围动脉血栓形成、心血管疾病再住院、术后1年全因死亡影响的OR值分别是1.269、1.304、0.977、1.089、1.315、1.335、0.896、0.774、1.191,但差异均无统计学意义(P>0.05)。结论:髋部骨折术后1年内,RIPC并未明显影响改变主要心血管不良事件的发生。非心脏手术中RIPC对临床心血管结局的长期影响需要在适当的随机临床试验中得到证实。
文摘目的探讨脑小血管(cerebral small vessel disease,CSVD)负担评分对短暂性脑缺血发作(transient ischemic attack,TIA)患者复发性脑血管事件(recurrence cerebrovascular events,RCVEs)的预测价值。材料与方法回顾性分析2019年10月至2022年12月期间于安徽省第二人民医院就诊的182例TIA患者病例资料,依据MRI检查计算CSVD总体负担评分,根据随访1个月内有无发生RCVEs分为RCVEs组(n=46)和未RCVEs组(n=136)。比较两组临床资料和CSVD总体负担评分,采用多因素logistic回归分析模型分析RCVEs的独立危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析CSVD影像特征得分及总负担评分对TIA患者RCVEs的预测价值。结果RCVEs组和未RCVEs组TIA发作次数、症状持续时间、既往高血压病史、CSVD总负担评分及分级情况比较差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示:TIA发作次数、症状持续时间、CSVD总负担评分是TIA患者发生RCVEs的独立危险因素(P<0.05)。ROC曲线分析结果显示:CSVD影像特征评分及总负担评分预测TIA患者发生RCVEs的曲线下面积(areas under the curve,AUC)分别为0.771(95%CI:0.673~0.869,P<0.001)、0.745(95%CI:0.655~0.835,P<0.001)、0.664(95%CI:0.549~0.780,P=0.009)、0.845(95%CI:0.766~0.924,P<0.001)、0.945(95%CI:0.896~0.994,P<0.001),其中CVSD总负担评分预测的AUC最高,当最佳截断值为2分时,敏感度为86.05%,特异度为83.02%。结论CSVD总负担评分对TIA患者发生RCVEs的预测价值良好,有助于临床评估TIA患者的短期预后。
文摘目的:探讨主动强化风险干预联合抚触对新生儿缺氧缺血性脑病(Hypoxic-Ischemic encephalopathy,HIE)患儿风险事件及发育的影响。方法:选取2020年1月至2023年1月本院新生儿科收治的70例HIE患儿作为研究对象,根据随机数字表法分为对照组和研究组,各35例。对照组采用常规护理联合抚触干预,研究组实施主动强化风险干预联合抚触干预。分析比较两组风险事件,体格生长指标、精神运动及智力发育情况。结果:干预期间,研究组风险事件发生率明显低于对照组(P<0.05)。研究组身高、体重、头围增长值均明显高于对照组(P<0.05)。干预后,两组精神运动发育指数(Psychomotor development index,PDI)、智力发育指数(Mental development index,MDI)评分均较干预前升高,且研究组高于对照组(P<0.05)。结论:主动强化风险干预联合抚触能减少新生儿HIE护理风险事件的发生,还能促进患儿体格发育、改善精神运动及智力发育。
