Evaluation of modified hemodilution combined therapy in the treatment of acute ischemic stroke in the elderly

BACKGROUND: Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal. OBJECTIVE: To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method. DESIGN: 1∶1 paired grouping according to gender and controlled observation. SETTING: Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University. PARTICIPANTS: Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items. According to 1∶1 paired principle in gender, 90 enrolled patients were assigned into treated group (n=45) and control group (n=45). There were 39 male and 6 female in the treatment group, and they were aged (76±6)years, ranging from 71 to 84 years, and hospitalized at the 14th to 76th hours after onset. There were 39 male and 6 female in the control group, and they were aged (76±6)years , ranging from 70 to 82 years, and hospitalized at the 16th to 72th hours after onset. METHODS: Therapeutic method: Patients of treated group received modified hemodilution combined therapy. 200 mL whole blood of patients was exchanged with 500 mL dextran-40 (including 20 mL danshen parenteral solution and 32 mg heparin) at the beginning of therapy; From the 2nd day, compound huangqi tea bag (Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid) was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4 ℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton(Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ) and 50 g/L glucose of 500 mL, 75 mg acetosal was taken orally, once a day, 14 days in total. ② Measurement and observation of index: Blood coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference (1995) was used to evaluate the recovery of neurological function of the patients in two groups at the 3rd, 5th, 7th and 14th days after therapy. ③Therapeutic effect and adverse effect were observed at the same time. MAIN OUTCOME MEASURES: ① Changes of coagulation index, blood lipid level and hemorheology; ② Blood flow rate of middle cerebral artery and NDS of patients with acute ischemic stroke in two groups; ③Adverse effect of drug. RESULTS: Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died of severe pulmonary infection. The rest 88 patients entered the stage of result analysis. ① Change of coagulation index and platelet aggregation rate: prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group: (18.4±1.9), (41.8±2.1), (19.7±1.7) s, Before therapy in treated group: (13.4±1.3), (35.8±1.3), (12.5±0.9) s, After therapy in control group: (16.9±1.5), (39.1±1.1), (11.9±2.1) s, P < 0.05];Concentration of fibrinogen (Fbg) after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group: (3.4±0.4) g/L; Before therapy in treated group: (4.3±0.7) g/L; After therapy in control group:(4.0±0.6) g/L; P < 0.05]. Platelet aggregation rate decreased from (37.92 ±0.85)% before therapy to (26.42±1.01)% after therapy (P < 0.01). ②Change of blood lipid level: Levels of total cholesterol (TC), triacylglycerol(TG) and low density lipoprotein cholesterol (LDL-C) of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group: (5.2±0.9), (1.9±0.9), (2.08±1.1) mmol/L, before therapy in treated group:(5.9±1.2), (2.8±0.9), (3.94±0.5) mmol/L, After therapy in control group: (6.0±1.1), (2.6±0.8), (3.84±0.9) mmol/L,P < 0.05]. ③ Change of hemorheology index: Hematocrit of patients of treated group was significantly lower after therapy than before therapy [Before therapy: (43.84±4.55)%;After therapy: (40.48±4.02)%;P < 0.05]. ④ Blood flow rate of middle cerebral artery of patients of treated group was significantly lower before therapy than after therapy [(90±1.2),(97±2.1) cm/s,P < 0.01]. ⑤ NDS of patients in treated group was significantly lower than of control group 14 days after therapy. The total effective rate after therapy was significantly higher in the treated group than in the control group (93%,78%, P < 0.05). ⑥There was no obvious adverse effect. CONCLUSION: Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit, increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.

Clinical evaluation of timing of endovascular embolization treatment for intracranial aneurysm

Objective To evaluate the effects of endovascular embolization treatment for intracranial aneurysms in different time. Methods The clinical data of 165 cases of ruptured intracranial aneurysm treated by endovascular treatment were analysed retrospectively. The patients were divided into 3 groups accrodding to

Utility of positron emission tomography-computed tomography scan in detecting residual hepatocellular carcinoma post treatment:Series of case reports

BACKGROUND Multi-phase computed tomography(CT)or magnetic resonance imaging(MRI)has been the standard of care for hepatocellular carcinoma(HCC)diagnosis for years.CASE SUMMARY We report a case series of four patients in whom positron emission tomographycomputed tomography(PET-CT)scan complemented the conventional CT/MRI scans in evaluating treatment response.In these four cases the conventional multi-phase CT and MRI failed to identify residual HCC disease post-treatment,while PET-CT complemented and aided in treatment response evaluation.In each case,the addition of PET-CT identified and located residual HCC disease,allowed retreatment,and altered medical management.CONCLUSION This case series suggests that PET-CT should perhaps play a role in the HCC management algorithm,in addition to the conventional contrast-enhanced multiphase scans.

Numerical modeling and performance evaluation of passive convergence-permeable reactive barrier(PC-PRB)

The passive convergence-permeable reactive barrier(PC-PRB)was proposed to address the limitations of traditional PRB configurations.To evaluate the hydraulic and pollutant removal performance of the PC-PRB system,we developed a simulation code named PRB-Trans.This code uses the two-dimensional(2D)finite element method to simulate groundwater flow and solute transport.Case studies demonstrate that PC-PRB technology is more efficient and cost-effective than continuous permeable reactive barrier(C-PRB)in treating the same contaminated plume.Implementation of PC-PRB technology results in a 33.3%and 72.7%reduction in PRB length(L_(PRB))and height(H_(PRB)),respectively,while increasing 2D horizontal and 2D vertical pollutant treatment efficiencies of PRB by 87.8%and 266.8%,respectively.In addition,the PC-PRB technology has the ability to homogenize the pollutant concentration and pollutant flux through the PRB system,which can mitigate the problems arising from uneven distribution of pollutants in the C-PRB to some extent.The L_(PRB)required for PC-PRB decreases as the water pipe length(L_(p))increases,while the H_(PRB)required initially decreases and then increases with increasing L_(p).The effect of passive well height(Hw)on H_(PRB)is not as significant as that of L_(p)on H_(PRB).Overall,PC-PRB presents a promising and advantageous PRB configuration in the effective treatment of various types of contaminated plumes.

Overexpression of wild-type HRAS drives non-alcoholic steatohepatitis to hepatocellular carcinoma in mice

Hepatocellular carcinoma(HCC),a prevalent solid carcinoma of significant concern,is an aggressive and often fatal disease with increasing global incidence rates and poor therapeutic outcomes.The etiology and pathological progression of non-alcoholic steatohepatitis(NASH)-related HCC is multifactorial and multistage.However,no single animal model can accurately mimic the full NASH-related HCC pathological progression,posing considerable challenges to transition and mechanistic studies.Herein,a novel conditional inducible wild-type human HRAS overexpressed mouse model(HRAS-HCC)was established,demonstrating 100%morbidity and mortality within approximately one month under normal dietary and lifestyle conditions.Advanced symptoms of HCC such as ascites,thrombus,internal hemorrhage,jaundice,and lung metastasis were successfully replicated in mice.In-depth pathological features of NASH-related HCC were demonstrated by pathological staining,biochemical analyses,and typical marker gene detections.Combined murine anti-PD-1 and sorafenib treatment effectively prolonged mouse survival,further confirming the accuracy and reliability of the model.Based on protein-protein interaction(PPI)network and RNA sequencing analyses,we speculated that overexpression of HRAS may initiate the THBS1-COL4A3 axis to induce NASH with severe fibrosis,with subsequent progression to HCC.Collectively,our study successfully duplicated natural sequential progression in a single murine model over a very short period,providing an accurate and reliable preclinical tool for therapeutic evaluations targeting the NASH to HCC continuum.