Extracorporeal membrane oxygenation states basilar artery thrombectomy and left posterior cerebral artery stent thrombectomy:A case report

BACKGROUND Extracorporeal membrane oxygenation(ECMO)is a new type of extracorporeal respiratory and circulatory assistance device.It can drain venous blood out of the body and inject it into veins or arteries after being oxygenated by an oxygenator(membrane lung)to replace lung and heart functions in a short time.ECMO can provide tissue blood perfusion and gas exchange almost equivalent to cardiac output and extend the effective treatment time window for patients with acute circulatory failure to restore cardiopulmonary function.CASE SUMMARY We report a case of an 81-year-old woman who underwent whole cerebral angiography,basilar artery thrombectomy and stent thrombectomy in the posterior artery of the left brain after implantation of ECMO.The patient was admitted to the hospital due to myocardial infarction.Considering that the cause of the patient’s disturbance of consciousness was unknown and cerebrovascular accident could not be ruled out after the implantation of ECMO,the department of Radioactive Intervention performed cerebral angiography.And the result of the angiography indicated vascular occlusion.After the basilar artery thrombectomy and stent thrombectomy in the posterior artery of the left brain,the patency of the occlusive vessel was achieved.CONCLUSION Although the patient eventually died of circulatory failure,the result of this case verifies the feasibility of cerebral angiography and thrombectomy in patients with implanted ECMO in the intubated state.

COVID-19: Africa’s Challenge and the Need for a Paradigm Shift on the Use of Ventilators

Background: The December 2019 Chinese epidemic of Corona Virus Disease [COVID-19], which erupted in Wuhan, South China, was declared a pandemic, by the World Health Organization [WHO], on 12th January 2020. The worldwide spread from China was rapid, but Africa was the last port-of-call. Her first diagnosed case was two months after China’s, on 14th February, 2020 in Egypt. The morbidity and mortality rates have, however, remained lower in Africa than in the developed world, and analysts believe that it was more of a temporary respite, since Africa’s poor health infrastructure will become her eventual albatross. Methodology: Data were collected on COVID-19 and records of the socio-economic capacity of Africa by accessing the relevant previous and current peer-reviewed publications from multiple search engines on internet. The data were, then, collated and comparatively analyzed. Results: The available data revealed that Africa had, mostly, the milder forms of COVID-19, and so, morbidity and mortality were low. Her shrinking elderly population and hot climate were believed to be contributory, but lately, as the pandemic spread, the role of these factors was not exactly predictive. Being low on healthcare infrastructure, Africa could tenaciously leverage on the supportive and preventive measures prescribed by WHO, while the world awaited a vaccine. The role of ventilators in the care of critically ill patients, also, came under scrutiny as some workers were questioning the underlying pathology, and advocating a paradigm shift from high-tech positive end expiratory pressure ventilation to plasmapheresis and packed cell transfusion. Conclusion: Africa faces a huge challenge with COVID-19, but the predicted heavy mortalities may be reduced by some local confounding factors, control of spread and re-focusing of critical care away from the expensive and unavailable ventilators.

Study of establishing disease-syndrome combined with animal model for immune thrombocytopenic purpura without additional conditions

Objective:To explore the feasibility of establishing the disease-syndrome combined animal model for immune thrombocytopenic purpura(ITP)without additional conditions.Methods:Three batches of data related to the ITP model mice obtained by replication at different time were analyzed,and whether the APS-injected model mice replicated through the passive immune modeling method could simulate the pathogenesis and clinical characteristics of human ITP was evaluated according to the differentiation criteria for diseasesyndrome combined model.Results:The APS-injected replicated ITP model mice possessed the following traits:(1)Compared with the normal group,the platelet count was significantly decreased,and coagulation time was significantly increased in the model group(P<.01).(2)Compared with the normal group,the medullary thrombocytogenous megakaryocytes were significantly decreased(P<.05,.01,.001).(3)The APS-injected sites and other parts of the model mice had spontaneous hemorrhage.(4)Behavioral changing signs were observed 1 week after the modeling(i.e.low activity,delayed activity,poor appetite,skin petechia/hemorrhage and spontaneous hemorrhage at the injected sites or other parts),and were getting more and more severe.Conclusion:According to the syndrome differentiation criteria for disease-syndrome combined model of ITP,the APS-injected animal model of ITP replicated through the passive immune modeling method without additional conditions possesses the characteristics of disease-syndrome combined model.It provides an ideal tool for the development of traditional Chinese medicine pharmacology experiment.

The possible role and clinical implication of myeloid-derived suppressor cells in the peripheral blood of patients with hepatitis B virus-related acute-on-chronic liver failure

Objective To explore the possible role and clinical implications of myeloid-derived suppressor cells(MDSC)in the peripheral blood of patients with hepatitis B virus(HBV)-related acute-on-chronic liver failure(HBVACLF).Methods A total of 25 HBV-ACLF patients