Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI...Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.展开更多
Objective：To explore the relationship between the needle-retaining time and the therapeutic effect of acupuncture in the treatment of ischemic stroke patients. Methods： Based on the level of the severity of the pati...Objective：To explore the relationship between the needle-retaining time and the therapeutic effect of acupuncture in the treatment of ischemic stroke patients. Methods： Based on the level of the severity of the patient＇s disease and the duration of acupuncture needle-retaining, 245 ischemic stroke inpatients were divided into 20 min, 40 min and 60 min groups according to the stratified random method. Acupoints used were Jianyu （肩髃LI 15）, Quchi （曲池LI 11）, Waiguan （外关TE 5）, Hegu （合谷LI 4）, etc. and stimulated electrically （2 Hz, sparse waves, an endurable strength） for 20 min, 40 min and 60 min respectively by using an electroacupuncture therapeutic apparatus. The treatment was given once daily, with 10 sessions being a therapeutic course. The severity of clinical neurological deficit was scored before and after the treatment Results： The results showed that acupuncture could improve the neurological deficit severity of ischemic stroke patients. The therapeutic effect of acupuncture in improving myodynamia of the upper limbs and hands, and the total score of 60 min group was the best, followed by 40 min group and 20 min group respectively,of acupuncture needle retention has a better therapeutic effect in the treatment indicating that longer duration of acupuncture needle retention has a better therapeutic effect in the treatment of stroke. Conclusion： There is a positive relationship between the needle-retaining time and the curative effect in improving ischemic stroke patients＇clinical symptoms and signs by acupuncture.展开更多
BACKGROUND Traditional limitations of cold static storage(CSS)on ice at 4℃during lung transplantation have necessitated limiting cold ischemic time(CIT)to 4-6 hours.Ex vivo lung perfusion(EVLP)can extend this preserv...BACKGROUND Traditional limitations of cold static storage(CSS)on ice at 4℃during lung transplantation have necessitated limiting cold ischemic time(CIT)to 4-6 hours.Ex vivo lung perfusion(EVLP)can extend this preservation time through the suspension of CIT and normothermic perfusion.As we continue to further expand the donor pool in all aspects of lung transplantation,teams are frequently traveling further distances to procure organs.AIM To determine the effect of CSS or EVLP on donors with extended travel distance[>750 nautical miles(NM)]to recipient.METHODS Lung transplants,whose donor traveled greater than 750 NM,were identified from the United Network for Organ Sharing Database.Recipients were stratified into either:CSS or EVLP,based on preservation method.Groups were assessed with comparative statistics and survival was assessed by Kaplan-Meier methods.A 3:1 propensity match was then created,and same analysis was repeated.RESULTS Prior to matching,those in the EVLP group had significantly increased postoperative morbidity to include dialysis,ventilator use,acute rejection,and treated rejection in the first year(P<0.05 for all).However,there were no significant differences in midterm survival(P=0.18).Following matching,those in the EVLP group again had significantly increased post-operative morbidity to include dialysis,extracorporeal membrane oxygenation use,ventilator use,and treated rejection in the first year(P<0.05 for all).As before,there were no significant differences in midterm survival following matching(P=0.08).CONCLUSION While there was no significant difference in survival,EVLP patients had increased peri-operative morbidity.With the advent of changes in CSS with 10℃storage further analysis is necessary to evaluate the best methods for utilizing organs from increased distances.展开更多
AIM To evaluate the effect of long haul airplane transport of donor livers on post-transplant outcomes. METHODS A retrospective cohort study of patients who received a liver transplantation was performed in Perth, Aus...AIM To evaluate the effect of long haul airplane transport of donor livers on post-transplant outcomes. METHODS A retrospective cohort study of patients who received a liver transplantation was performed in Perth, Australia from 1992 to 2012. Donor and recipient characteristics information were extracted from Western Australian liver transplantation service database. Patients were followed up for a mean of six years. Patient and graft survival were evaluated and compared between patients who received a local donor liver and those who received an airplane transported donor liver. Predictors of survival were determined by univariate and multivariate analysis using cox regression.RESULTS One hundred and ninety-three patients received alocal donor liver and 93 patients received an airplane transported donor liver. Airplane transported livers had a significantly lower alanine transaminase(mean: 45 U/L vs 84 U/L, P = 0.035), higher donor risk index(mean: 1.88 vs 1.42, P < 0.001) and longer cold ischemic time(CIT)(mean: 10.1 h vs 6.4 h, P < 0.001). There was a weak correlation between CIT and transport distance(r2 = 0.29, P < 0.001). Mean follow up was six years and 93 patients had graft failure. Multivariate analysis found only airplane transport retained significance for graft loss(HR = 1.92, 95%CI: 1.16-3.17). One year graft survival was 0.88 for those with a local liver and was 0.71 for those with an airplane transported liver. One year graft loss was due to primary graft non-function or associated with preservation injury in 20.8% of recipients of an airplane transported liver compared with 4.6% in those with a local liver(P = 0.027). CONCLUSION Airplane transport of donor livers was independently associated with reduced graft survival following liver transplantation.展开更多
With the advancement of medical technique and application of the new immunosuppressant agents, cardiac transplantation has become an effective treatment for end-stage heart disease caused by different reasons. The ort...With the advancement of medical technique and application of the new immunosuppressant agents, cardiac transplantation has become an effective treatment for end-stage heart disease caused by different reasons. The orthotopic procedure has been performed in many countries nowadays. Whether it is successful or not mainly depends on harvesting the denoted heart, operative technique and perioperative management.展开更多
Knee dislocations frequently involve vascular injuries that demand early diagnosis and timely intervention. Time of ischemia is pivotal in determining the outcome for the limb, delays in treatment beyond 8 hours signi...Knee dislocations frequently involve vascular injuries that demand early diagnosis and timely intervention. Time of ischemia is pivotal in determining the outcome for the limb, delays in treatment beyond 8 hours significantly increase the risk of limb loss. Unfortunately, this critical window is often missed in resource-limited settings. Here we report a 25-year-old female sustained a left knee injury after falling into a trench. She was diagnosed with an open knee dislocation accompanied by a popliteal artery injury. However, revascularization was delayed for 18 hours due to limited resources, including the unavailability of a thrombectomy catheter. Postoperatively, the patient received anticoagulation therapy with serial limb assessments and after 3 weeks the laceration healed and the limb was still viable. Knee dislocations frequently result in vascular injury (popliteal artery most common), making prompt diagnosis and intervention essential for limb preservation. In settings with limited resources, like ours, delayed presentation and transfer to specialized centers contribute to prolonged ischemic times. Nonetheless, viable limbs should be revascularized in stable patients, even with prolonged ischemia. This case highlights the importance of limb revascularization despite delay. Efforts should be made to improve prompt diagnosis, timely referral, and availability of necessary equipment for vascular repair to optimize outcomes in similar cases.展开更多
In this study, we established a Wistar rat model of right middle cerebral artery occlusion and observed pathological imaging changes （T2-weighted imaging [T2WI], T2FLAIR, and diffusion-weighted imaging [DWI]） follow...In this study, we established a Wistar rat model of right middle cerebral artery occlusion and observed pathological imaging changes （T2-weighted imaging [T2WI], T2FLAIR, and diffusion-weighted imaging [DWI]） following cerebral infarction. The pathological changes were divided into three phases： early cerebral infarction, middle cerebral infarction, and late cerebral infarction. In the early cerebral infarction phase （less than 2 hours post-infarction）, there was evidence of intracellular edema, which improved after reperfusion. This improvement was defined as the ischemic penumbra. In this phase, a high DWI signal and a low apparent diffusion coefficient were observed in the right basal ganglia region. By contrast, there were no abnormal T2WI and T2FLAIR signals. For the middle cerebral infarction phase （2-4 hours post-infarction）, a mixed edema was observed. After reperfusion, there was a mild improvement in cell edema, while the angioedema became more serious. A high DWI signal and a low apparent diffusion coefficient signal were observed, and some rats showed high T2WI and T2FLAIR signals. For the late cerebral infarction phase （4-6 hours post-infarction）, significant angioedema was visible in the infarction site. After reperfusion, there was a significant increase in angioedema, while there was evidence of hemorrhage and necrosis. A mixed signal was observed on DWI, while a high apparent diffusion coefficient signal, a high T2WI signal, and a high T2FLAIR signal were also observed. All 86 cerebral infarction patients were subjected to T2WI, T2FLAIR, and DWI. MRI results of clinic data similar to the early infarction phase of animal experiments were found in 51 patients, for which 10 patients （10/51） had an onset time greater than 6 hours. A total of 35 patients had MRI results similar to the middle and late infarction phase of animal experiments, of which eight patients （8/35） had an onset time less than 6 hours. These data suggest that defining the ＂therapeutic time window＂ as the time 6 hours after infarction may not be suitable for all patients. Integrated application of MRI sequences including T2WI, T2FLAIR, DW-MRI, and apparent diffusion coefficient mapping should be used to examine the ischemic penumbra, which may provide valuable information for identifying the ＂therapeutic time window＂.展开更多
文摘Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.
文摘Objective：To explore the relationship between the needle-retaining time and the therapeutic effect of acupuncture in the treatment of ischemic stroke patients. Methods： Based on the level of the severity of the patient＇s disease and the duration of acupuncture needle-retaining, 245 ischemic stroke inpatients were divided into 20 min, 40 min and 60 min groups according to the stratified random method. Acupoints used were Jianyu （肩髃LI 15）, Quchi （曲池LI 11）, Waiguan （外关TE 5）, Hegu （合谷LI 4）, etc. and stimulated electrically （2 Hz, sparse waves, an endurable strength） for 20 min, 40 min and 60 min respectively by using an electroacupuncture therapeutic apparatus. The treatment was given once daily, with 10 sessions being a therapeutic course. The severity of clinical neurological deficit was scored before and after the treatment Results： The results showed that acupuncture could improve the neurological deficit severity of ischemic stroke patients. The therapeutic effect of acupuncture in improving myodynamia of the upper limbs and hands, and the total score of 60 min group was the best, followed by 40 min group and 20 min group respectively,of acupuncture needle retention has a better therapeutic effect in the treatment indicating that longer duration of acupuncture needle retention has a better therapeutic effect in the treatment of stroke. Conclusion： There is a positive relationship between the needle-retaining time and the curative effect in improving ischemic stroke patients＇clinical symptoms and signs by acupuncture.
基金Supported by The Jewel and Frank Benson Family Endowmentand The Jewel and Frank Benson Research Professorship.
文摘BACKGROUND Traditional limitations of cold static storage(CSS)on ice at 4℃during lung transplantation have necessitated limiting cold ischemic time(CIT)to 4-6 hours.Ex vivo lung perfusion(EVLP)can extend this preservation time through the suspension of CIT and normothermic perfusion.As we continue to further expand the donor pool in all aspects of lung transplantation,teams are frequently traveling further distances to procure organs.AIM To determine the effect of CSS or EVLP on donors with extended travel distance[>750 nautical miles(NM)]to recipient.METHODS Lung transplants,whose donor traveled greater than 750 NM,were identified from the United Network for Organ Sharing Database.Recipients were stratified into either:CSS or EVLP,based on preservation method.Groups were assessed with comparative statistics and survival was assessed by Kaplan-Meier methods.A 3:1 propensity match was then created,and same analysis was repeated.RESULTS Prior to matching,those in the EVLP group had significantly increased postoperative morbidity to include dialysis,ventilator use,acute rejection,and treated rejection in the first year(P<0.05 for all).However,there were no significant differences in midterm survival(P=0.18).Following matching,those in the EVLP group again had significantly increased post-operative morbidity to include dialysis,extracorporeal membrane oxygenation use,ventilator use,and treated rejection in the first year(P<0.05 for all).As before,there were no significant differences in midterm survival following matching(P=0.08).CONCLUSION While there was no significant difference in survival,EVLP patients had increased peri-operative morbidity.With the advent of changes in CSS with 10℃storage further analysis is necessary to evaluate the best methods for utilizing organs from increased distances.
文摘AIM To evaluate the effect of long haul airplane transport of donor livers on post-transplant outcomes. METHODS A retrospective cohort study of patients who received a liver transplantation was performed in Perth, Australia from 1992 to 2012. Donor and recipient characteristics information were extracted from Western Australian liver transplantation service database. Patients were followed up for a mean of six years. Patient and graft survival were evaluated and compared between patients who received a local donor liver and those who received an airplane transported donor liver. Predictors of survival were determined by univariate and multivariate analysis using cox regression.RESULTS One hundred and ninety-three patients received alocal donor liver and 93 patients received an airplane transported donor liver. Airplane transported livers had a significantly lower alanine transaminase(mean: 45 U/L vs 84 U/L, P = 0.035), higher donor risk index(mean: 1.88 vs 1.42, P < 0.001) and longer cold ischemic time(CIT)(mean: 10.1 h vs 6.4 h, P < 0.001). There was a weak correlation between CIT and transport distance(r2 = 0.29, P < 0.001). Mean follow up was six years and 93 patients had graft failure. Multivariate analysis found only airplane transport retained significance for graft loss(HR = 1.92, 95%CI: 1.16-3.17). One year graft survival was 0.88 for those with a local liver and was 0.71 for those with an airplane transported liver. One year graft loss was due to primary graft non-function or associated with preservation injury in 20.8% of recipients of an airplane transported liver compared with 4.6% in those with a local liver(P = 0.027). CONCLUSION Airplane transport of donor livers was independently associated with reduced graft survival following liver transplantation.
文摘With the advancement of medical technique and application of the new immunosuppressant agents, cardiac transplantation has become an effective treatment for end-stage heart disease caused by different reasons. The orthotopic procedure has been performed in many countries nowadays. Whether it is successful or not mainly depends on harvesting the denoted heart, operative technique and perioperative management.
文摘Knee dislocations frequently involve vascular injuries that demand early diagnosis and timely intervention. Time of ischemia is pivotal in determining the outcome for the limb, delays in treatment beyond 8 hours significantly increase the risk of limb loss. Unfortunately, this critical window is often missed in resource-limited settings. Here we report a 25-year-old female sustained a left knee injury after falling into a trench. She was diagnosed with an open knee dislocation accompanied by a popliteal artery injury. However, revascularization was delayed for 18 hours due to limited resources, including the unavailability of a thrombectomy catheter. Postoperatively, the patient received anticoagulation therapy with serial limb assessments and after 3 weeks the laceration healed and the limb was still viable. Knee dislocations frequently result in vascular injury (popliteal artery most common), making prompt diagnosis and intervention essential for limb preservation. In settings with limited resources, like ours, delayed presentation and transfer to specialized centers contribute to prolonged ischemic times. Nonetheless, viable limbs should be revascularized in stable patients, even with prolonged ischemia. This case highlights the importance of limb revascularization despite delay. Efforts should be made to improve prompt diagnosis, timely referral, and availability of necessary equipment for vascular repair to optimize outcomes in similar cases.
基金supported by the National Natural Science Foundation of China,No.30960399,and No.81160181
文摘In this study, we established a Wistar rat model of right middle cerebral artery occlusion and observed pathological imaging changes （T2-weighted imaging [T2WI], T2FLAIR, and diffusion-weighted imaging [DWI]） following cerebral infarction. The pathological changes were divided into three phases： early cerebral infarction, middle cerebral infarction, and late cerebral infarction. In the early cerebral infarction phase （less than 2 hours post-infarction）, there was evidence of intracellular edema, which improved after reperfusion. This improvement was defined as the ischemic penumbra. In this phase, a high DWI signal and a low apparent diffusion coefficient were observed in the right basal ganglia region. By contrast, there were no abnormal T2WI and T2FLAIR signals. For the middle cerebral infarction phase （2-4 hours post-infarction）, a mixed edema was observed. After reperfusion, there was a mild improvement in cell edema, while the angioedema became more serious. A high DWI signal and a low apparent diffusion coefficient signal were observed, and some rats showed high T2WI and T2FLAIR signals. For the late cerebral infarction phase （4-6 hours post-infarction）, significant angioedema was visible in the infarction site. After reperfusion, there was a significant increase in angioedema, while there was evidence of hemorrhage and necrosis. A mixed signal was observed on DWI, while a high apparent diffusion coefficient signal, a high T2WI signal, and a high T2FLAIR signal were also observed. All 86 cerebral infarction patients were subjected to T2WI, T2FLAIR, and DWI. MRI results of clinic data similar to the early infarction phase of animal experiments were found in 51 patients, for which 10 patients （10/51） had an onset time greater than 6 hours. A total of 35 patients had MRI results similar to the middle and late infarction phase of animal experiments, of which eight patients （8/35） had an onset time less than 6 hours. These data suggest that defining the ＂therapeutic time window＂ as the time 6 hours after infarction may not be suitable for all patients. Integrated application of MRI sequences including T2WI, T2FLAIR, DW-MRI, and apparent diffusion coefficient mapping should be used to examine the ischemic penumbra, which may provide valuable information for identifying the ＂therapeutic time window＂.
