AIM To investigate if patent foramen ovale(PFO) closure device reduces the risk of recurrent stroke in patients with cryptogenic stroke.METHODS We searched five databases-Pub Med,EMBASE,Cochrane,CINAHL and Web-of-Scie...AIM To investigate if patent foramen ovale(PFO) closure device reduces the risk of recurrent stroke in patients with cryptogenic stroke.METHODS We searched five databases-Pub Med,EMBASE,Cochrane,CINAHL and Web-of-Science and clinicaltrials.gov from January 2000 to September 2017 for randomized trials comparing PFO closure to medical therapy in cryptogenic stroke.Heterogeneity was determined using Cochrane's Q statistics.Random effects model was used.RESULTS Five randomized controlled trials with 3440 patients were included in the analysis.Mean follow-up was 50 ± 20 mo.PFO closure was associated with a 41% reduction in incidence of recurrent strokes when compared to medical therapy alone in patients with cryptogenic stroke [risk ratio(RR): 0.59,95%CI: 0.40-0.87,P = 0.008].Atrial fibrillation was higher with device closure when compared to medical therapy alone(RR: 4.97,95%CI: 2.22-11.11,P < 0.001).There was no difference between the two groups with respect to all-cause mortality,major bleeding or adverse events.CONCLUSION PFO device closure in appropriately selected patients with moderate to severe right-to-left shunt and/or atrial septal aneurysm shows benefit with respect to recurrent strokes,particularly in younger patients.Further studies are essential to evaluate the impact of higher incidence of atrial fibrillation seen with the PFO closure device on long-term mortality and stroke rates.展开更多
BACKGROUND Cardiogenic embolism caused by patent foramen ovale(PFO)is a common etiology of cryptogenic stroke(CS),particularly in young and middle-aged patients.Studies about right-to-left shunt(RLS)detection using co...BACKGROUND Cardiogenic embolism caused by patent foramen ovale(PFO)is a common etiology of cryptogenic stroke(CS),particularly in young and middle-aged patients.Studies about right-to-left shunt(RLS)detection using contrast-enhanced transcranial Doppler(c-TCD)are numerous.According to the time phase and number of microbubbles detected on c-TCD,RLS can be classified and graded.We hypothesized that the characteristics of an infarction lesion on diffusion-weighted imaging differs when combining the type and grade of RLS on c-TCD in patients with PFO-related CS.AIM To explore the characteristics of infarction lesions on diffusion-weighted imaging when combining the RLS type and grade determined by c-TCD.METHODS We retrospectively evaluated CS patients from August 2015 to December 2019 at a tertiary hospital.In total,111 PFO-related CS patients were divided according to whether RLS was permanent(microbubbles detected both at resting state and after the Valsalva maneuver)or latent(microbubbles detected only after the Valsalva maneuver)on c-TCD.Each group was subdivided into small,mild and large RLS according to the grade of shunt on c-TCD.A normal control group was composed of 33 patients who suffered from simple dizziness.Intragroup and intergroup differences were analyzed in terms of clinical,laboratory and diffusion-weighted imaging lesion characteristics.The correlation between RLS grade evaluated by c-TCD and size of PFO determined by transesophageal echocardiography were also analyzed.RESULTS In 111 patients with PFO-related CS,68 had permanent RLS and 43 had latent RLS.Clinical characteristics and laboratory tests were not significantly different among the permanent RLS,latent RLS and normal control groups.The proportion of patients with multiple territory lesions in the permanent RLS group(50%)was larger than that in the latent RLS group(27.91%;P=0.021).Posterior circulation was more likely to be affected in the latent RLS group than in the permanent RLS group(30.23%vs 8.82%,P=0.004).Permanent-large and latent-large RLS were both more likely to be related to multiple(P_(trend)=0.017 and 0.009,respectively),small(P_(trend)=0.035 and 0.006,respectively)and cortical(P_(trend)=0.031 and 0.033,respectively)lesions.The grade of RLS evaluated by c-TCD was correlated to the size of PFO determined by transesophageal echocardiography(r=0.758,P<0.001).CONCLUSION Distribution of the infarct suggested the possible type of RLS.Multiple,small and cortical infarcts suggest large RLS induced by a large PFO.展开更多
Eustachian valve is an embryonic endocardial heart structure;after birth it becomes an embryogenic residue and its persistance in adult life is unusual.</span><span style="font-family:Verdana;">&...Eustachian valve is an embryonic endocardial heart structure;after birth it becomes an embryogenic residue and its persistance in adult life is unusual.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The literature reports some cases of association between Eustachian valve and PFO and is known that the prominent Eustachian valve can represent a way facilitating systemic embolism.</span><span style="font-family:""></span><span style="font-family:Verdana;">Several studies also investigated the role of Eustachian valve in the pathophysiology of both migraine and cerebral embolism.</span><span style="font-family:Verdana;"> </span><span style="font-family:""><span style="font-family:Verdana;">In addiction is known how Eustachian valve may increase the risk of endocarditis, which mostly affects intravenous drug abusers or those with implanted medical devices or central venous catheters. The most commonly identified organism is </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;"> (approximately 53% of cases).</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We present a case of a 46-year-old woman with known migraine. She was</span><span style="font-family:Verdana;"> hospitalized in Stroke Unit for a cryptogenic stroke with a right-to-left shunt detected with transcranial doppler ultrasound with “bubble test” and a patent foramen ovale with right-to-left shunt with a fenestration of atrial septum and a voluminous Eustachian valve detected with transesophageal echocardiography;she developed fever with a blood cultures positive for methicillin-resis</span><span style="font-family:Verdana;">- </span><span style="font-family:""><span style="font-family:Verdana;">tant </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;"> (MRSA), even if without evidence of endocarditis vegetations.</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In summary</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the objective of our paper is to present an example of a correlation between the persistence of the Eustachian valve with bothcryptogenetic stroke, possible valve infection and migraine.展开更多
Objectives: Concerns regarding the real efficacy of transcatheter patent foramen ovale (PFO) closure versus medical therapy in patients with cryptogenic stroke remained unresolved. We performed a meta-analysis using t...Objectives: Concerns regarding the real efficacy of transcatheter patent foramen ovale (PFO) closure versus medical therapy in patients with cryptogenic stroke remained unresolved. We performed a meta-analysis using the randomized controlled trials on the efficacy and safety of transcatheter PFO closure in patients with cryptogenic stroke. Methods: Web of Science, EMBASE, PubMed, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs). The primary outcome was recurrent stroke and transient-ischemic attack (TIA). Original data, hazard ratio (HR) with 95% confidence interval (95% CI) were abstracted to calculate a pooled effect size. Results: Our meta-analysis showed benefit with device closure when compared with medical therapy with an HR of 0.54 (95% CI: 0.39 - 0.74, P = 0.108) in the intention-to-treat cohort, 0.44 (95% CI: 0.24 - 0.82, P = 0.103) in the per-protocol populations, and 0.43 (95% CI: 0.31 - 0.60, P = 0.019) in the as-treated populations. There was a significantly higher incidence of new-onset atrial fibrillation in PFO closure patients (OR = 4.53, 95% CI: 2.58 - 7.97, P = 0.094). PFO Patients with an atrial septal aneurysm benefit from device closure (OR = 0.39, 95% CI: 0.22 - 0.69, P = 0.053). Patients with a substantial PFO shunt benefit the greatest with device closure with a pooled OR of 0.27 (95% CI: 0.14 - 0.56, P = 0.525). Conclusions: The meta-analysis concluded that PFO closure was associated with significantly lower risk of recurrent stroke in PFO patients with cryptogenic stroke than with medical therapy alone. The benefit of PFO closure was greater in patients with a substantial shunt and atrial septal aneurysm. PFO closure was associated with higher rates of new-onset atrial fibrillation.展开更多
Patent foram ovale(PFO)is the most common anatomical cause of an interarterial shunt.It is usually asymptomatic but may cause paradoxical embolism and is a risk factor for non-lacunar cryptogenic cerebral ischemia in ...Patent foram ovale(PFO)is the most common anatomical cause of an interarterial shunt.It is usually asymptomatic but may cause paradoxical embolism and is a risk factor for non-lacunar cryptogenic cerebral ischemia in young adults.Although the first clinical trials did not show a significant superiority of PFO closure in the secondary prevention of cerebral ischemia as compared with standard antithrombotic treatment,six subsequent randomized clinical trials(CLOSURE I,PC Trial,RESPECT,CLOSE,REDUCE,and DEFENSE-PFO)performed in a sample of cryptogenic stroke in patients aged 60 years or younger provided evidence of a significant reduction of recurrent cerebral ischemia after percutaneous PFO closure.However,the use of percutaneous PFO closure cannot be generalized to the entire population of patients with cerebral ischemia and PFO,but it is indicated in highly selected patients with non-lacunar cryptogenic cerebral infarction with a large right-to-left shunt,an atrial septal aneurysm and no evidence of atrial fibrillation,as well as in association with antithrombotic treatment for an optimal secondary prevention of cerebral ischemia.展开更多
Objective:To investigate the value of contrast-enhanced transcranial doppler(c-TCD)in the diagnosis of patent foramen ovale(PFO)of patients with migraine and cryptogenic stroke.Methods:A retrospective analysis of 160 ...Objective:To investigate the value of contrast-enhanced transcranial doppler(c-TCD)in the diagnosis of patent foramen ovale(PFO)of patients with migraine and cryptogenic stroke.Methods:A retrospective analysis of 160 patients undergoing c-TCD monitoring in our hospital from June 2014 to June 2019 was performed.Among them,there were 80 cases of patients with migraine(38 cases with aura and 42 cases without aura)in group A,and 80 cases of patients with cryptogenic stroke in group B.The positive detectable rate of PFO in the two groups were calculated and analyzed.Results:The detectable rate was 50.00%in group A,and 40.00%in group B.There was no statistical significance between the two groups(P>0.05).Among them,the detectable rate of PFO in migraine with aura in group A(62.50%)was higher than that in group B(37.50%).The difference was statistically significant(P<0.05);In the two groups of PFO-positive patients,the difference didn’t have statistical significance,comparing the proportion of the inherent type to that of potential type(P>0.05);There was no statistical significance of the difference between the RLS incidence of grade I and that of grade II among two groups of PFO-positive patients(P>0.05);the incidence of RLS in grade III in group B(50.00%)was higher than that in group A(25.00%),and the difference was statistically significant(P<0.05).Conclusion:c-TCD can accurately screen migraine and cryptogenic stroke caused by PFO,and grade and classify it as a clinical diagnosis of migraine and cryptogenic caused by PFO.It can also act as a objective reference of estimating the effect of treatment in different diseases and preventing cryptogenic stroke.展开更多
Background The incidence of cryptogenic stroke(CS)accounts for about 25%of ischemic stroke.Current studies have shown that cryptogenic stroke is closely related to patent foramen ovale(PFO).Evaluating the correlation ...Background The incidence of cryptogenic stroke(CS)accounts for about 25%of ischemic stroke.Current studies have shown that cryptogenic stroke is closely related to patent foramen ovale(PFO).Evaluating the correlation between PFO and CS needs to be combined with multidisciplinary evaluation.Many clinical studies have shown that drug therapy can reduce the risk of ischemic stroke in elderly PFO patients(>60 years old).However,whether elderly PFO patients(>60 years old)can benefit from PFO closure is still controversial.This article reviewed the research progress of drug therapy and PFO closure therapy for cryptogenic stroke associated with PFO in the elderly.[S Chin J Cardiol 2024;25(1):50-56].展开更多
Objective:To explore the influencing factors and logistic regression characteristics of cryptogenic stroke in patients with positive transcranial doppler bubble test(c-TCD).Methods:A total of 134 cases of cryptogenic ...Objective:To explore the influencing factors and logistic regression characteristics of cryptogenic stroke in patients with positive transcranial doppler bubble test(c-TCD).Methods:A total of 134 cases of cryptogenic stroke that were diagnosed by Tianshui First People's Hospital from November 2018 to April 2020 were selected according to the TOAST(Trial of ORG 10172 in Acute Stroke Treatment)classification criteria.According to c-TCD results,there were 70 cases of right to left shunt that were included in the positive group and 64 cases without right to left shunt in the negative group.Gender,age,smoking,diabetes,hypertension,and factors affecting the positive rate of foam were analyzed.According to the abnormal embolism scale scores,logistic regression equation was used to analyze the independent influencing factors.Results:The influencing factors of cryptogenic stroke in patients with positive c-TCD were correlated with age,gender,and abnormal embolism scale scores(p<0.05).For each grade increase in age,the proportion of positive foam test was calculated to be 3.21 times,and the proportion of female to male was calculated to be 2.25 times.For each grade increase in the scores,the proportion of positive foam test was calculated to be 2.55 times.Conclusion:Female,older age,and higher scores in the abnormal embolism scale are the influencing factors for cryptogenic stroke in patients with positive c-TCD.展开更多
给出一种CENTU MC S3000集散控制系统中分离信号软件模块的分程控制方案。提出利用该模块的信号分配功能，可以产生一种新型分程控制模式，即不必调整阀门定位器的机电机构就能使送到两个控制阀的输入信号范围均为0％-100％。通过应用...给出一种CENTU MC S3000集散控制系统中分离信号软件模块的分程控制方案。提出利用该模块的信号分配功能，可以产生一种新型分程控制模式，即不必调整阀门定位器的机电机构就能使送到两个控制阀的输入信号范围均为0％-100％。通过应用软件组态能够实现分程控制。这种方法具有工程实施省时省力、节省资金，控制效果更加准确可靠等优点，克服了传统分程控制参数调整不方便且稳定性较差等缺点。在石油化工企业的釜式间歇反应器温度分程控制和精馏塔塔压分程控制等系统中，有着广泛的应用前景。展开更多
Patent foramen ovale (PFO) is a common congenital cardiac defect. It is usually </span></span><span style="white-space:normal;"><span style="font-family:"">asympto...Patent foramen ovale (PFO) is a common congenital cardiac defect. It is usually </span></span><span style="white-space:normal;"><span style="font-family:"">asymptomatic, but it can be associated with relevant clinical manifestations such as cryptogenic stroke and platypnea-orthodeoxia syndrome. We present the case of a patient with hemodynamically significant carotid artery stenosis who underwent endarterectomy for a transient ischemic attack (TIA). After surgery, the patient presented an ischemic stroke due to M2 occlusion treated with mechanical thrombectomy. During hospitalization</span></span><span style="white-space:normal;"><span style="font-family:"">,</span></span><span style="white-space:normal;"><span style="font-family:""> a distal bilateral deep vein thrombosis was found. The patient developed respiratory failure due to a massive right-to-left shunt through a large PFO (platypnea-orthodeoxia syndrome).</span></span><span style="white-space:normal;"><span style="font-family:""> These findings are consistent with the hypothesis that the TIA and the subsequential ischemic stroke were related to paradoxical embolism rather than atherothromboembolism. The aim of our case report is to raise awareness of the possible complications of such a common finding as PFO.展开更多
目的本研究旨在探讨卵圆孔未闭(PFO)相关隐源性穿支动脉梗死(PI)患者的临床特征及超声心动图改变。方法回顾性纳入2015年1月—2023年12月确诊为隐源性卒中的患者,通过经颅多普勒超声(TCD)发泡试验诊断PFO。比较PI患者中对比PFO-PI组与非...目的本研究旨在探讨卵圆孔未闭(PFO)相关隐源性穿支动脉梗死(PI)患者的临床特征及超声心动图改变。方法回顾性纳入2015年1月—2023年12月确诊为隐源性卒中的患者,通过经颅多普勒超声(TCD)发泡试验诊断PFO。比较PI患者中对比PFO-PI组与非PFO-PI组的临床特征及经胸超声心动图检查(TTE)结果,在PFO组患者中比较PI与皮质梗死(CI)的差异。结果研究共纳入251例患者进行回顾性分析。104例患者检出PFO,其中40.4%(42/104)为PFO-PI,59.6%(62/104)为PFO-CI。在未合并PFO的患者中,30.6%(45/147)为非PFO-PI。与非PFO-PI患者相比,PFO-PI患者椎基底动脉系统梗死(VCI)比例显著升高(47.6%vs 17.8%,P=0.003);左心室舒张末期内径(LVEDd)均数更小(47.3 mm vs 49.8 mm,P=0.037);E波峰值流速(Em)更低(62.6 cm/s vs 70.8 cm/s,P=0.015)。在PFO患者中,与PFO-CI组(34.5 mm和49.4 mm)相比,PFO-PI组主动脉根部内径(ARd)均数更小(32.5 mm,P=0.011),LVEDd均数更低(47.3 mm,P=0.045)。结论PFO-PI患者中VCI发生率更高。同时,LVEDd减小,Em降低以及较小的ARd是与PFO-PI相关的三项超声心动图特征。展开更多
文摘AIM To investigate if patent foramen ovale(PFO) closure device reduces the risk of recurrent stroke in patients with cryptogenic stroke.METHODS We searched five databases-Pub Med,EMBASE,Cochrane,CINAHL and Web-of-Science and clinicaltrials.gov from January 2000 to September 2017 for randomized trials comparing PFO closure to medical therapy in cryptogenic stroke.Heterogeneity was determined using Cochrane's Q statistics.Random effects model was used.RESULTS Five randomized controlled trials with 3440 patients were included in the analysis.Mean follow-up was 50 ± 20 mo.PFO closure was associated with a 41% reduction in incidence of recurrent strokes when compared to medical therapy alone in patients with cryptogenic stroke [risk ratio(RR): 0.59,95%CI: 0.40-0.87,P = 0.008].Atrial fibrillation was higher with device closure when compared to medical therapy alone(RR: 4.97,95%CI: 2.22-11.11,P < 0.001).There was no difference between the two groups with respect to all-cause mortality,major bleeding or adverse events.CONCLUSION PFO device closure in appropriately selected patients with moderate to severe right-to-left shunt and/or atrial septal aneurysm shows benefit with respect to recurrent strokes,particularly in younger patients.Further studies are essential to evaluate the impact of higher incidence of atrial fibrillation seen with the PFO closure device on long-term mortality and stroke rates.
基金People’s Livelihood Science and Technology Project(Research on Application of Key Technologies)of Suzhou(No.SS202061)Technical Cooperation Project of Soochow University(No.H211064).
文摘BACKGROUND Cardiogenic embolism caused by patent foramen ovale(PFO)is a common etiology of cryptogenic stroke(CS),particularly in young and middle-aged patients.Studies about right-to-left shunt(RLS)detection using contrast-enhanced transcranial Doppler(c-TCD)are numerous.According to the time phase and number of microbubbles detected on c-TCD,RLS can be classified and graded.We hypothesized that the characteristics of an infarction lesion on diffusion-weighted imaging differs when combining the type and grade of RLS on c-TCD in patients with PFO-related CS.AIM To explore the characteristics of infarction lesions on diffusion-weighted imaging when combining the RLS type and grade determined by c-TCD.METHODS We retrospectively evaluated CS patients from August 2015 to December 2019 at a tertiary hospital.In total,111 PFO-related CS patients were divided according to whether RLS was permanent(microbubbles detected both at resting state and after the Valsalva maneuver)or latent(microbubbles detected only after the Valsalva maneuver)on c-TCD.Each group was subdivided into small,mild and large RLS according to the grade of shunt on c-TCD.A normal control group was composed of 33 patients who suffered from simple dizziness.Intragroup and intergroup differences were analyzed in terms of clinical,laboratory and diffusion-weighted imaging lesion characteristics.The correlation between RLS grade evaluated by c-TCD and size of PFO determined by transesophageal echocardiography were also analyzed.RESULTS In 111 patients with PFO-related CS,68 had permanent RLS and 43 had latent RLS.Clinical characteristics and laboratory tests were not significantly different among the permanent RLS,latent RLS and normal control groups.The proportion of patients with multiple territory lesions in the permanent RLS group(50%)was larger than that in the latent RLS group(27.91%;P=0.021).Posterior circulation was more likely to be affected in the latent RLS group than in the permanent RLS group(30.23%vs 8.82%,P=0.004).Permanent-large and latent-large RLS were both more likely to be related to multiple(P_(trend)=0.017 and 0.009,respectively),small(P_(trend)=0.035 and 0.006,respectively)and cortical(P_(trend)=0.031 and 0.033,respectively)lesions.The grade of RLS evaluated by c-TCD was correlated to the size of PFO determined by transesophageal echocardiography(r=0.758,P<0.001).CONCLUSION Distribution of the infarct suggested the possible type of RLS.Multiple,small and cortical infarcts suggest large RLS induced by a large PFO.
文摘Eustachian valve is an embryonic endocardial heart structure;after birth it becomes an embryogenic residue and its persistance in adult life is unusual.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The literature reports some cases of association between Eustachian valve and PFO and is known that the prominent Eustachian valve can represent a way facilitating systemic embolism.</span><span style="font-family:""></span><span style="font-family:Verdana;">Several studies also investigated the role of Eustachian valve in the pathophysiology of both migraine and cerebral embolism.</span><span style="font-family:Verdana;"> </span><span style="font-family:""><span style="font-family:Verdana;">In addiction is known how Eustachian valve may increase the risk of endocarditis, which mostly affects intravenous drug abusers or those with implanted medical devices or central venous catheters. The most commonly identified organism is </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;"> (approximately 53% of cases).</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">We present a case of a 46-year-old woman with known migraine. She was</span><span style="font-family:Verdana;"> hospitalized in Stroke Unit for a cryptogenic stroke with a right-to-left shunt detected with transcranial doppler ultrasound with “bubble test” and a patent foramen ovale with right-to-left shunt with a fenestration of atrial septum and a voluminous Eustachian valve detected with transesophageal echocardiography;she developed fever with a blood cultures positive for methicillin-resis</span><span style="font-family:Verdana;">- </span><span style="font-family:""><span style="font-family:Verdana;">tant </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;"> (MRSA), even if without evidence of endocarditis vegetations.</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">In summary</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the objective of our paper is to present an example of a correlation between the persistence of the Eustachian valve with bothcryptogenetic stroke, possible valve infection and migraine.
文摘Objectives: Concerns regarding the real efficacy of transcatheter patent foramen ovale (PFO) closure versus medical therapy in patients with cryptogenic stroke remained unresolved. We performed a meta-analysis using the randomized controlled trials on the efficacy and safety of transcatheter PFO closure in patients with cryptogenic stroke. Methods: Web of Science, EMBASE, PubMed, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs). The primary outcome was recurrent stroke and transient-ischemic attack (TIA). Original data, hazard ratio (HR) with 95% confidence interval (95% CI) were abstracted to calculate a pooled effect size. Results: Our meta-analysis showed benefit with device closure when compared with medical therapy with an HR of 0.54 (95% CI: 0.39 - 0.74, P = 0.108) in the intention-to-treat cohort, 0.44 (95% CI: 0.24 - 0.82, P = 0.103) in the per-protocol populations, and 0.43 (95% CI: 0.31 - 0.60, P = 0.019) in the as-treated populations. There was a significantly higher incidence of new-onset atrial fibrillation in PFO closure patients (OR = 4.53, 95% CI: 2.58 - 7.97, P = 0.094). PFO Patients with an atrial septal aneurysm benefit from device closure (OR = 0.39, 95% CI: 0.22 - 0.69, P = 0.053). Patients with a substantial PFO shunt benefit the greatest with device closure with a pooled OR of 0.27 (95% CI: 0.14 - 0.56, P = 0.525). Conclusions: The meta-analysis concluded that PFO closure was associated with significantly lower risk of recurrent stroke in PFO patients with cryptogenic stroke than with medical therapy alone. The benefit of PFO closure was greater in patients with a substantial shunt and atrial septal aneurysm. PFO closure was associated with higher rates of new-onset atrial fibrillation.
文摘Patent foram ovale(PFO)is the most common anatomical cause of an interarterial shunt.It is usually asymptomatic but may cause paradoxical embolism and is a risk factor for non-lacunar cryptogenic cerebral ischemia in young adults.Although the first clinical trials did not show a significant superiority of PFO closure in the secondary prevention of cerebral ischemia as compared with standard antithrombotic treatment,six subsequent randomized clinical trials(CLOSURE I,PC Trial,RESPECT,CLOSE,REDUCE,and DEFENSE-PFO)performed in a sample of cryptogenic stroke in patients aged 60 years or younger provided evidence of a significant reduction of recurrent cerebral ischemia after percutaneous PFO closure.However,the use of percutaneous PFO closure cannot be generalized to the entire population of patients with cerebral ischemia and PFO,but it is indicated in highly selected patients with non-lacunar cryptogenic cerebral infarction with a large right-to-left shunt,an atrial septal aneurysm and no evidence of atrial fibrillation,as well as in association with antithrombotic treatment for an optimal secondary prevention of cerebral ischemia.
基金Health Commission of Ningxia Hui Autonomous Region(2017-NW-066)。
文摘Objective:To investigate the value of contrast-enhanced transcranial doppler(c-TCD)in the diagnosis of patent foramen ovale(PFO)of patients with migraine and cryptogenic stroke.Methods:A retrospective analysis of 160 patients undergoing c-TCD monitoring in our hospital from June 2014 to June 2019 was performed.Among them,there were 80 cases of patients with migraine(38 cases with aura and 42 cases without aura)in group A,and 80 cases of patients with cryptogenic stroke in group B.The positive detectable rate of PFO in the two groups were calculated and analyzed.Results:The detectable rate was 50.00%in group A,and 40.00%in group B.There was no statistical significance between the two groups(P>0.05).Among them,the detectable rate of PFO in migraine with aura in group A(62.50%)was higher than that in group B(37.50%).The difference was statistically significant(P<0.05);In the two groups of PFO-positive patients,the difference didn’t have statistical significance,comparing the proportion of the inherent type to that of potential type(P>0.05);There was no statistical significance of the difference between the RLS incidence of grade I and that of grade II among two groups of PFO-positive patients(P>0.05);the incidence of RLS in grade III in group B(50.00%)was higher than that in group A(25.00%),and the difference was statistically significant(P<0.05).Conclusion:c-TCD can accurately screen migraine and cryptogenic stroke caused by PFO,and grade and classify it as a clinical diagnosis of migraine and cryptogenic caused by PFO.It can also act as a objective reference of estimating the effect of treatment in different diseases and preventing cryptogenic stroke.
基金supported by the National Natural Science Foundation of China(No.81370242)the Guangdong Provincial College Students Innovation and Entrepreneurship Training Program in 2023(No.S202310571076)+3 种基金the Zhanjiang Science and Technology Program(No.2022A01166/No.2022A01183)the Non-funded Science and Technology Research Program of Zhanjiang(No.2021B01145)the Guangdong Medical University Youth Scientific Research Training Fund(No.GDMUQ2021011)the Universty-level Innovation and Entrepreneurship Training Program of Guangdong Medical University(No.GDMU2021163/No.GDMU2021207)。
文摘Background The incidence of cryptogenic stroke(CS)accounts for about 25%of ischemic stroke.Current studies have shown that cryptogenic stroke is closely related to patent foramen ovale(PFO).Evaluating the correlation between PFO and CS needs to be combined with multidisciplinary evaluation.Many clinical studies have shown that drug therapy can reduce the risk of ischemic stroke in elderly PFO patients(>60 years old).However,whether elderly PFO patients(>60 years old)can benefit from PFO closure is still controversial.This article reviewed the research progress of drug therapy and PFO closure therapy for cryptogenic stroke associated with PFO in the elderly.[S Chin J Cardiol 2024;25(1):50-56].
基金The research belongs to the stage result of a project(Project plan number:2021-SHFZKJK-5207).
文摘Objective:To explore the influencing factors and logistic regression characteristics of cryptogenic stroke in patients with positive transcranial doppler bubble test(c-TCD).Methods:A total of 134 cases of cryptogenic stroke that were diagnosed by Tianshui First People's Hospital from November 2018 to April 2020 were selected according to the TOAST(Trial of ORG 10172 in Acute Stroke Treatment)classification criteria.According to c-TCD results,there were 70 cases of right to left shunt that were included in the positive group and 64 cases without right to left shunt in the negative group.Gender,age,smoking,diabetes,hypertension,and factors affecting the positive rate of foam were analyzed.According to the abnormal embolism scale scores,logistic regression equation was used to analyze the independent influencing factors.Results:The influencing factors of cryptogenic stroke in patients with positive c-TCD were correlated with age,gender,and abnormal embolism scale scores(p<0.05).For each grade increase in age,the proportion of positive foam test was calculated to be 3.21 times,and the proportion of female to male was calculated to be 2.25 times.For each grade increase in the scores,the proportion of positive foam test was calculated to be 2.55 times.Conclusion:Female,older age,and higher scores in the abnormal embolism scale are the influencing factors for cryptogenic stroke in patients with positive c-TCD.
文摘给出一种CENTU MC S3000集散控制系统中分离信号软件模块的分程控制方案。提出利用该模块的信号分配功能，可以产生一种新型分程控制模式，即不必调整阀门定位器的机电机构就能使送到两个控制阀的输入信号范围均为0％-100％。通过应用软件组态能够实现分程控制。这种方法具有工程实施省时省力、节省资金，控制效果更加准确可靠等优点，克服了传统分程控制参数调整不方便且稳定性较差等缺点。在石油化工企业的釜式间歇反应器温度分程控制和精馏塔塔压分程控制等系统中，有着广泛的应用前景。
文摘Patent foramen ovale (PFO) is a common congenital cardiac defect. It is usually </span></span><span style="white-space:normal;"><span style="font-family:"">asymptomatic, but it can be associated with relevant clinical manifestations such as cryptogenic stroke and platypnea-orthodeoxia syndrome. We present the case of a patient with hemodynamically significant carotid artery stenosis who underwent endarterectomy for a transient ischemic attack (TIA). After surgery, the patient presented an ischemic stroke due to M2 occlusion treated with mechanical thrombectomy. During hospitalization</span></span><span style="white-space:normal;"><span style="font-family:"">,</span></span><span style="white-space:normal;"><span style="font-family:""> a distal bilateral deep vein thrombosis was found. The patient developed respiratory failure due to a massive right-to-left shunt through a large PFO (platypnea-orthodeoxia syndrome).</span></span><span style="white-space:normal;"><span style="font-family:""> These findings are consistent with the hypothesis that the TIA and the subsequential ischemic stroke were related to paradoxical embolism rather than atherothromboembolism. The aim of our case report is to raise awareness of the possible complications of such a common finding as PFO.
文摘目的本研究旨在探讨卵圆孔未闭(PFO)相关隐源性穿支动脉梗死(PI)患者的临床特征及超声心动图改变。方法回顾性纳入2015年1月—2023年12月确诊为隐源性卒中的患者,通过经颅多普勒超声(TCD)发泡试验诊断PFO。比较PI患者中对比PFO-PI组与非PFO-PI组的临床特征及经胸超声心动图检查(TTE)结果,在PFO组患者中比较PI与皮质梗死(CI)的差异。结果研究共纳入251例患者进行回顾性分析。104例患者检出PFO,其中40.4%(42/104)为PFO-PI,59.6%(62/104)为PFO-CI。在未合并PFO的患者中,30.6%(45/147)为非PFO-PI。与非PFO-PI患者相比,PFO-PI患者椎基底动脉系统梗死(VCI)比例显著升高(47.6%vs 17.8%,P=0.003);左心室舒张末期内径(LVEDd)均数更小(47.3 mm vs 49.8 mm,P=0.037);E波峰值流速(Em)更低(62.6 cm/s vs 70.8 cm/s,P=0.015)。在PFO患者中,与PFO-CI组(34.5 mm和49.4 mm)相比,PFO-PI组主动脉根部内径(ARd)均数更小(32.5 mm,P=0.011),LVEDd均数更低(47.3 mm,P=0.045)。结论PFO-PI患者中VCI发生率更高。同时,LVEDd减小,Em降低以及较小的ARd是与PFO-PI相关的三项超声心动图特征。
