The safety limitation of large new-built seagoing ves- sel design and operation is investigated to ensure safety of the new vessels towed through bridge area. We analyze the maneuverabil- ity characteristics of a towi...The safety limitation of large new-built seagoing ves- sel design and operation is investigated to ensure safety of the new vessels towed through bridge area. We analyze the maneuverabil- ity characteristics of a towing fleet, and develop a mathematical drift model of ship motion for the fleet. Based on this drift model and the hydro-meteorological conditions in bridge area, we pro- pose a method to systematically ascertain the safety limitations of water stages, current, wind, speed and visibility. This method is conducive to the safety of both navigation and bridges when large towing fleets transit through bridges.展开更多
Large size vessels sailing in continuous level ice and broken ice of high concentration are mostly assisted by icebreakers.This is done in order to provide for fast transportation through the North Sea Route and safe ...Large size vessels sailing in continuous level ice and broken ice of high concentration are mostly assisted by icebreakers.This is done in order to provide for fast transportation through the North Sea Route and safe operation in extreme ice conditions.Currently,new large size gas and oil carriers and container ships are being designed and built with beams much greater than the beams of existing icebreakers.At the same time,no mathematical description exists for the breaking mechanism of ice channel edges,when such vessels move under icebreaker escort.This paper suggests a simple method for assessment of the ice resistance in the case of a large ship running in an icebreaker channel;the method is based on modification of well-known semi-empirical methods for calculation of the ice resistance to ships in level and broken ice.The main feature of the proposed calculation scheme consists in that different methods are applied to estimate the ice resistance in broken ice and due to breaking of level ice edges.The combination of these methods gives a deliverable ice resistance of a large size vessel moving under icebreaker assistance in a newly made ice channel.In general,proposed method allows to define the speed of a carrier moving in an ice channel behind a modern linear icebreaker and could be applied at the ship design stage and during development of the marine transportation system.The paper also discusses the ways for further refinement of the assessment procedure suggested.展开更多
Objectives To evaluate the very long-term safety and effectiveness of drug-eluting stents （DES） compared to bare-metal stents （BMS） for patients with large coronary vessels. Methods From April 2004 to October 2006...Objectives To evaluate the very long-term safety and effectiveness of drug-eluting stents （DES） compared to bare-metal stents （BMS） for patients with large coronary vessels. Methods From April 2004 to October 2006, 2407 consecutive patients undergoing de novo lesion percutaneous coronary intervention with reference vessel diameter greater than or equal to 3.5 mm at Fu Wai Hospital in Beijing, China, were prospectively enrolled into this study. We obtained 9-year clinical outcomes including death, myocardial infarction （MI）, thrombosis, target lesion revascularization （TLR）, target vessel revascularization （TVR）, and major adverse cardiac events （MACE, the composite of death, MI, and TVR）. We performed Cox＇s proportional-hazards models to assess relative risks of all the outcome measures after propensity match. Results After propensity scoring, 514 DES-treated patients were matched to 514 BMS-treated patients. The patients treated with BMS were associated with higher risk ofTLR （HR： 2.55, 95%CI： 1.520-4.277, P = 0.0004） and TVR （HR： 1.889, 95%CI： 1.185-3.011, P = 0.0075）, but the rates of death/MI and MACE were not statistically different. All Academic Research Consortium definition stent thrombosis at 9-year were comparable in the two groups. Conclusions During long-term follow-up through nine years, use of DES in patients with large coronary arteries was still associated with significant reductions in the risks of TLR and TVR.展开更多
Objective: To determine the effectiveness of antiplatelet and/or anticoagulant therapy (AP/AC) at reducing ischemic events in patients with Large Vessel Vasculitis (LVV). Methods: We performed a random effects meta-an...Objective: To determine the effectiveness of antiplatelet and/or anticoagulant therapy (AP/AC) at reducing ischemic events in patients with Large Vessel Vasculitis (LVV). Methods: We performed a random effects meta-analysis of studies examining antiplatelet and/or anticoagulant therapy (AP/AC) and ischemic events in Takayasu’s Arteritis (TAK) or Giant Cell Arteritis (GCA). Severe ischemic events were defined as stroke, ischemic ocular manifestations and claudication symptoms. Any ischemic event included jaw claudication in addition to the above manifestations. Results: Seven studies met inclusion criteria: 1 TAK and 6 GCA. The majority of patients (>80%) were treated with ASA and treatment was initiated prior to diagnosis of LVV. Risk of severe and any ischemic event in patients with LVV treated with AP/AC versus no treatment was not significantly different (OR 0.570, 95% CI 0.243, 1.340 and OR 0.594, 95% CI 0.248, 1.421, respectively). For studies with follow-up data (26-76 months), AP/AC was protective for severe ischemic events (OR 0.18, 95% CI 0.04, 0.83). Findings were similar when excluding studies that did not account for potential confounders, such as cardiovascular risk factors. Conclusion: At follow-up, antiplatelet therapy significantly decreases ischemic events in patients with LVV. However, in most cases of GCA, the treatment was initiated prior to the diagnosis of vasculitis. The benefit of initiating anti-platelet therapy at the time of GCA diagnosis remains unclear.展开更多
BACKGROUND Musculoskeletal involvement in primary large vessel vasculitis(LVV),including giant cell arteritis and Takayasu's arteritis(TAK),tends to be subacute.With the progression of arterial disease,patients ma...BACKGROUND Musculoskeletal involvement in primary large vessel vasculitis(LVV),including giant cell arteritis and Takayasu's arteritis(TAK),tends to be subacute.With the progression of arterial disease,patients may develop polyarthralgia and myalgias,mainly involving muscle stiffness,limb/jaw claudication,cold/swelling extremities,etc.Acute development of rhabdomyolysis in addition to aortic aneurysm is uncommon in LVV.Herein,we report a rare case of LVV with the first presentation of acute rhabdomyolysis.CASE SUMMARY A 70-year-old Asian woman suffering from long-term low back pain was hospitalized due to limb claudication,dark urine and an elevated creatine kinase(CK)level.After treatment with fluid resuscitation and antibiotics,the patient remained febrile.Her workup showed persistent elevated levels of inflammatory markers,and imaging studies revealed an aortic aneurysm.A decreasing CK was evidently combined with elevated inflammatory markers and negativity for antineutrophilic cytoplasmic antibodies.LVV was suspected and confirmed by magnetic resonance angiography and positron emission tomography with 18Ffluorodeoxyglucose/computed tomography.With a favourable response to immunosuppressive treatment,her symptoms resolved,and clinical remission was achieved one month later.However,after failing to follow the tapering schedule,the patient was readministered 25 mg/d prednisolone due to disease relapse.Follow-up examinations showed decreased inflammatory markers and substantial improvement in artery lesions after 6 mo of treatment.At the twelvemonth follow-up,she was clinically stable and maintained on corticosteroid therapy.CONCLUSION An exceptional presentation of LVV with acute rhabdomyolysis is described in this case,which exhibited a good response to immunosuppressive therapy,suggesting consideration for a differential diagnosis when evaluating febrile patients with myalgia and elevated CK.Timely use of high-dose steroids until a diagnosis is established may yield a favourable outcome.展开更多
Acute ischemic stroke is one of the common discases in Chinese,among which acute ischemic stroke with large vessel occlusion(AIS-LVO)has thc most serious complications and has the risk of death.Studies have shown that...Acute ischemic stroke is one of the common discases in Chinese,among which acute ischemic stroke with large vessel occlusion(AIS-LVO)has thc most serious complications and has the risk of death.Studies have shown that reperfusion is a first-line treatment for the effective rescue of ischemic brain tissue,usually mainly by mechanical|hrombectomy(MT),supplemented by intravenous thrombolysis.However,there are still complications after large blood vessel occlusion and MT.such as blecding and infection at the puncture point,vasospasm,vascular dissection,subarachnoid hemorrhage,hcmonhagic transfomation,reembolization,and massive cerebral infarction,ctc.The high risk factors and corresponding measures of complications after MT by revicwing the rescarch analysis.展开更多
Patients who received endovascular therapy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO) and large-scaled core infarct volume in the time window were analyzed. Literature data were reviewed. Re...Patients who received endovascular therapy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO) and large-scaled core infarct volume in the time window were analyzed. Literature data were reviewed. Results showed that although EVT is the first choice to AIS-LVO, patients often have poor prognosis. Alberta stroke program early CT score (ASPECTS) based on computerized tomography angiography source image (CTA-SI) can reflect the real cerebral perfusion more truly, and it can assess the size of core infarct more quickly and accurately, thus enabling to judge prognosis.展开更多
BACKGROUND Percutaneous transluminal coronary angioplasty,while an effective intervention,can frequently lead to acute occlusion with severe consequences.Although clinical trials have demonstrated the efficacy of drug...BACKGROUND Percutaneous transluminal coronary angioplasty,while an effective intervention,can frequently lead to acute occlusion with severe consequences.Although clinical trials have demonstrated the efficacy of drug-coated balloons(DCB)in treating acute coronary artery occlusion and in preventing restenosis,there has been limited exploration on the use of DCB in treating de novo lesions in large vessels.Currently,DCB are only recommended for patients with small vessel lesions and in-stent restenosis lesions,those at high risk of bleeding,and other special groups of patients.CASE SUMMARY This report presents a case of successful drug-coated balloon treatment of de novo lesions in large coronary vessels.Postoperatively,the patient demonstrated favorable recovery,with subsequent examination results revealing no significant differences from the previous examination.CONCLUSION The successful treatment of the patient in our case highlights the potential of DCB in the treatment of de novo lesions in large coronary vessels.展开更多
Objective:Early and accurate identification of large vessel occlusion(LVO)acute ischemic stroke(AIS)patients is critically important for stroke management.Practicable scales with simple items can facilitate prehospita...Objective:Early and accurate identification of large vessel occlusion(LVO)acute ischemic stroke(AIS)patients is critically important for stroke management.Practicable scales with simple items can facilitate prehospital paramedics distinguishing LVO-AIS patients with high efficiency and help to avoid unnecessary and costly delays.The current study aims to develop a screening tool to predict AIS-LVO patients based on prehospital available data.Method:A total of 251 suspected stroke patients who were transported to the emergency department of our hospital via emergency medical services were consecutively enrolled from August,2020 to January,2022.Data including demographic information,medical history,clinical manifestations,and vital signs were collected.A multivariate logistic regression model was developed based on statistically significant variables selected from univariate analysis.Result:Forty-two patients(16.7%)were diagnosed as LVO-AIS based on imaging validation at admission.A comprehensive model was developed with past medical history factors such as atrial fibrillation and coronary heart disease,vital signs such as systolic blood pressure,and prominent symptoms and signs such as gaze palsy,facial paralysis,and dysarthria.The model showed better diagnostic performance in terms of area under the receiver operating characteristic curves(0.884,95%CI,0.830-0.939),which was higher than other common prehospital prediction scales such as the Face,Arm,Speech,Time test(FAST),the Field Assessment Stroke Triage for Emergency Destination(FAST-ED)scale,and the Gaze-Face-Arm-Speech-Time test(G-FAST).Calibration curve analysis,decision curve analysis,and clinical impact curve analysis further validated the reliability,net benefit,and potential clinical impact of the prediction model,respectively.Conclusion:We conducted a prediction model based on prehospital accessible factors including past history of atrial fibrillation and coronary heart disease,systolic blood pressure,and signs such as gaze palsy,facial palsy,and dysarthria.The prediction model showed good diagnostic power and accuracy for identification of the high-risk patients with LVO and may become an effective tool for the LVO recognition in prehospital settings.Future studies are warranted to refine and validate the model further in order to enhance the accuracy and objectivity of clinical judgments.展开更多
Objective:To investigate the clinical effects of applying the magnetic resonance double mismatch technique to endovascular treatment of acute anterior circulation,large vessel occlusion with cerebral infarction in an ...Objective:To investigate the clinical effects of applying the magnetic resonance double mismatch technique to endovascular treatment of acute anterior circulation,large vessel occlusion with cerebral infarction in an unknown time window.Methods:The research work was carried out in our hospital,the work was carried out from November 2018 to November 2019,the patients with acute anterior circulation large vessel occlusion with cerebral infarction who were treated in our hospital during this period,100 patients,50 patients with an unknown time window and 50 patients with definite time window were selected,and they were named as the experimental and control groups,given different examination methods,were given to investigate the clinical treatment effect.Results:Patients’data on HIHSS score before treatment,the incidence of intracranial hemorrhage and rate of Mrs≤2 rating after 90 days of treatment were not significantly different(P>0.05),which was not meaningful.The differences in data between the two groups concerning HIHSS scores were relatively significant before,and after treatment(P<0.05).Conclusion:The magnetic resonance double mismatch technique will be applied in the endovascular treatment of acute anterior circulation large vessel occlusion with cerebral infarction of unknown time window.展开更多
Objective To summarize the clinical experience of frontotemporal expanded flap with bilateral superficial temporal vessels in repairing large area scar contracture in face and neck.Methods 14 patients with facial and ...Objective To summarize the clinical experience of frontotemporal expanded flap with bilateral superficial temporal vessels in repairing large area scar contracture in face and neck.Methods 14 patients with facial and Cervical scar contracture in our hospital were taken as the research object.With bilateral superficial temporal vessels as pedicles,a 400-600 ml skin dilator was inserted into the forehead and 50-100 ml skin dilator was inserted into the two temporal parts respectively.Within 3-4 months,the water injection volume reaches 2 times of the dilator volume.After maintaining for one month,skin flap transplantation was performed.The frontal flap was reserved for hairline reconstruction,and the flap was cut to cover the area after facial and Cervical scar release to reconstruct the jaw-neck angle.The pedicle division and pedicle trimming were performed 3-4 weeks after operation.Results All the 14 patients completed the operation successfully.The flap expansion time is 5-6 months.The expanded skin flap covers an area of 26 cm×9 cm-42 cm×16 cm,and all the skin flaps survived after operation.Among them,2 patients suffered from flap congestion after flap transplantation.Follow-up for 6-12 months showed that the color and texture of the skin flap were similar to those of facial skin,with natural transition and no obvious bloating.The angle between the lower jaw and the neck is about 90.The anterior flexion,posterior extension,lateral flexion and rotation of the neck are obviously improved compared with the anterior,and the posterior extension is close to normal.Conclusion Frontotemporal expanded flap with bilateral superficial temporal vessels is suitable for patients with large-area scar contracture in face and neck that cannot be repaired after expansion of adjacent local normal tissues.展开更多
In collaboration with 12 other institutions, the Meteorological Observation Center of the China Meteorological Administration undertook a comprehensive marine observation experiment in the South China Sea using the Yi...In collaboration with 12 other institutions, the Meteorological Observation Center of the China Meteorological Administration undertook a comprehensive marine observation experiment in the South China Sea using the Yilong-10 high-altitude large unmanned aerial vehicle(UAV). The Yilong-10 UAV carried a self-developed dropsonde system and a millimeter-wave cloud radar system. In addition, a solar-powered unmanned surface vessel and two drifting buoys were used. The experiment was further supported by an intelligent, reciprocating horizontal drifting radiosonde system that was deployed from the Sansha Meteorological Observing Station, with the intent of producing a stereoscopic observation over the South China Sea. Comprehensive three-dimensional observations were collected using the system from 31 July to2 August, 2020. This information was used to investigate the formation and development processes of Typhoon Sinlaku(2020). The data contain measurements of 21 oceanic and meteorological parameters acquired by the five devices, along with video footage from the UAV. The data proved very helpful in determining the actual location and intensity of Typhoon Sinlaku(2020). The experiment demonstrates the feasibility of using a high-altitude, large UAV to fill in the gaps between operational meteorological observations of marine areas and typhoons near China, and marks a milestone for the use of such data for analyzing the structure and impact of a typhoon in the South China Sea. It also demonstrates the potential for establishing operational UAV meteorological observing systems in the future, and the assimilation of such data into numerical weather prediction models.展开更多
Background Whether intravenous thrombolysis(IVT)should be administered prior to endovascular therapy(EVT)in patients with atherothrombotic stroke-related large vessel occlusion(AT-LVO)remains unclear.This study aimed ...Background Whether intravenous thrombolysis(IVT)should be administered prior to endovascular therapy(EVT)in patients with atherothrombotic stroke-related large vessel occlusion(AT-LVO)remains unclear.This study aimed to assess the efficacy and safety of IVT administered before EVT in this patient population.Methods We analysed the data from a multicentre registry of patients who underwent EVT for AT-LVO.Patients were categorised based on presumed mechanism of occlusion:in situ occlusion(intracranial group)or embolism from cervical artery occlusion/stenosis(tandem group).We compared the efficacy and safety of IVT before EVT in patients who received IVT(IVT stratum)and those who did not(non-IVT stratum).The primary outcome was a modified Rankin Scale score of 0-2 at 90 days.Results Among the 336 patients in the intracranial group,99 patients underwent IVT.The rate of favourable functional outcomes did not differ between IVT and non-IVT strata(51.1%vs 47.6%;adjusted ORs(aORs)(95%CI),1.18(0.66 to 2.09));whereas any intracranial haemorrhage(ICH)(10.1%vs 3.8%;aOR,2.98(1.01 to 9.26))and mortality at 90 days(6.4%vs 1.3%;aOR,4.66(1.02 to 26.73))were significantly higher in the IVT stratum.Among the 233 patients in the tandem group,88 patients underwent IVT,with no significant differences in efficacy or safety outcomes between the strata.Conclusion In patients with AT-LVO,IVT before EVT did not improve outcomes and was associated with increased risk of ICH and mortality in those with in situ intracranial occlusion.IVT before EVT may not be recommended in patients with atherosclerotic intracranial occlusions.展开更多
基金Supported by the Key Projects of Golden Waterway Transit Capacity Improving Technologies(201132822430)
文摘The safety limitation of large new-built seagoing ves- sel design and operation is investigated to ensure safety of the new vessels towed through bridge area. We analyze the maneuverabil- ity characteristics of a towing fleet, and develop a mathematical drift model of ship motion for the fleet. Based on this drift model and the hydro-meteorological conditions in bridge area, we pro- pose a method to systematically ascertain the safety limitations of water stages, current, wind, speed and visibility. This method is conducive to the safety of both navigation and bridges when large towing fleets transit through bridges.
基金This work was funded by the Russian Science Foundation(Grant No.17-79-20162-П).
文摘Large size vessels sailing in continuous level ice and broken ice of high concentration are mostly assisted by icebreakers.This is done in order to provide for fast transportation through the North Sea Route and safe operation in extreme ice conditions.Currently,new large size gas and oil carriers and container ships are being designed and built with beams much greater than the beams of existing icebreakers.At the same time,no mathematical description exists for the breaking mechanism of ice channel edges,when such vessels move under icebreaker escort.This paper suggests a simple method for assessment of the ice resistance in the case of a large ship running in an icebreaker channel;the method is based on modification of well-known semi-empirical methods for calculation of the ice resistance to ships in level and broken ice.The main feature of the proposed calculation scheme consists in that different methods are applied to estimate the ice resistance in broken ice and due to breaking of level ice edges.The combination of these methods gives a deliverable ice resistance of a large size vessel moving under icebreaker assistance in a newly made ice channel.In general,proposed method allows to define the speed of a carrier moving in an ice channel behind a modern linear icebreaker and could be applied at the ship design stage and during development of the marine transportation system.The paper also discusses the ways for further refinement of the assessment procedure suggested.
文摘Objectives To evaluate the very long-term safety and effectiveness of drug-eluting stents （DES） compared to bare-metal stents （BMS） for patients with large coronary vessels. Methods From April 2004 to October 2006, 2407 consecutive patients undergoing de novo lesion percutaneous coronary intervention with reference vessel diameter greater than or equal to 3.5 mm at Fu Wai Hospital in Beijing, China, were prospectively enrolled into this study. We obtained 9-year clinical outcomes including death, myocardial infarction （MI）, thrombosis, target lesion revascularization （TLR）, target vessel revascularization （TVR）, and major adverse cardiac events （MACE, the composite of death, MI, and TVR）. We performed Cox＇s proportional-hazards models to assess relative risks of all the outcome measures after propensity match. Results After propensity scoring, 514 DES-treated patients were matched to 514 BMS-treated patients. The patients treated with BMS were associated with higher risk ofTLR （HR： 2.55, 95%CI： 1.520-4.277, P = 0.0004） and TVR （HR： 1.889, 95%CI： 1.185-3.011, P = 0.0075）, but the rates of death/MI and MACE were not statistically different. All Academic Research Consortium definition stent thrombosis at 9-year were comparable in the two groups. Conclusions During long-term follow-up through nine years, use of DES in patients with large coronary arteries was still associated with significant reductions in the risks of TLR and TVR.
文摘Objective: To determine the effectiveness of antiplatelet and/or anticoagulant therapy (AP/AC) at reducing ischemic events in patients with Large Vessel Vasculitis (LVV). Methods: We performed a random effects meta-analysis of studies examining antiplatelet and/or anticoagulant therapy (AP/AC) and ischemic events in Takayasu’s Arteritis (TAK) or Giant Cell Arteritis (GCA). Severe ischemic events were defined as stroke, ischemic ocular manifestations and claudication symptoms. Any ischemic event included jaw claudication in addition to the above manifestations. Results: Seven studies met inclusion criteria: 1 TAK and 6 GCA. The majority of patients (>80%) were treated with ASA and treatment was initiated prior to diagnosis of LVV. Risk of severe and any ischemic event in patients with LVV treated with AP/AC versus no treatment was not significantly different (OR 0.570, 95% CI 0.243, 1.340 and OR 0.594, 95% CI 0.248, 1.421, respectively). For studies with follow-up data (26-76 months), AP/AC was protective for severe ischemic events (OR 0.18, 95% CI 0.04, 0.83). Findings were similar when excluding studies that did not account for potential confounders, such as cardiovascular risk factors. Conclusion: At follow-up, antiplatelet therapy significantly decreases ischemic events in patients with LVV. However, in most cases of GCA, the treatment was initiated prior to the diagnosis of vasculitis. The benefit of initiating anti-platelet therapy at the time of GCA diagnosis remains unclear.
基金Supported by Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2021KY833Traditional Chinese Medical Science and Technology Project of Zhejiang Province,No.2021ZB110.
文摘BACKGROUND Musculoskeletal involvement in primary large vessel vasculitis(LVV),including giant cell arteritis and Takayasu's arteritis(TAK),tends to be subacute.With the progression of arterial disease,patients may develop polyarthralgia and myalgias,mainly involving muscle stiffness,limb/jaw claudication,cold/swelling extremities,etc.Acute development of rhabdomyolysis in addition to aortic aneurysm is uncommon in LVV.Herein,we report a rare case of LVV with the first presentation of acute rhabdomyolysis.CASE SUMMARY A 70-year-old Asian woman suffering from long-term low back pain was hospitalized due to limb claudication,dark urine and an elevated creatine kinase(CK)level.After treatment with fluid resuscitation and antibiotics,the patient remained febrile.Her workup showed persistent elevated levels of inflammatory markers,and imaging studies revealed an aortic aneurysm.A decreasing CK was evidently combined with elevated inflammatory markers and negativity for antineutrophilic cytoplasmic antibodies.LVV was suspected and confirmed by magnetic resonance angiography and positron emission tomography with 18Ffluorodeoxyglucose/computed tomography.With a favourable response to immunosuppressive treatment,her symptoms resolved,and clinical remission was achieved one month later.However,after failing to follow the tapering schedule,the patient was readministered 25 mg/d prednisolone due to disease relapse.Follow-up examinations showed decreased inflammatory markers and substantial improvement in artery lesions after 6 mo of treatment.At the twelvemonth follow-up,she was clinically stable and maintained on corticosteroid therapy.CONCLUSION An exceptional presentation of LVV with acute rhabdomyolysis is described in this case,which exhibited a good response to immunosuppressive therapy,suggesting consideration for a differential diagnosis when evaluating febrile patients with myalgia and elevated CK.Timely use of high-dose steroids until a diagnosis is established may yield a favourable outcome.
基金High Level Talent Program of Hainan Natural Science Foundation(No.821RC680)。
文摘Acute ischemic stroke is one of the common discases in Chinese,among which acute ischemic stroke with large vessel occlusion(AIS-LVO)has thc most serious complications and has the risk of death.Studies have shown that reperfusion is a first-line treatment for the effective rescue of ischemic brain tissue,usually mainly by mechanical|hrombectomy(MT),supplemented by intravenous thrombolysis.However,there are still complications after large blood vessel occlusion and MT.such as blecding and infection at the puncture point,vasospasm,vascular dissection,subarachnoid hemorrhage,hcmonhagic transfomation,reembolization,and massive cerebral infarction,ctc.The high risk factors and corresponding measures of complications after MT by revicwing the rescarch analysis.
文摘Patients who received endovascular therapy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO) and large-scaled core infarct volume in the time window were analyzed. Literature data were reviewed. Results showed that although EVT is the first choice to AIS-LVO, patients often have poor prognosis. Alberta stroke program early CT score (ASPECTS) based on computerized tomography angiography source image (CTA-SI) can reflect the real cerebral perfusion more truly, and it can assess the size of core infarct more quickly and accurately, thus enabling to judge prognosis.
基金Supported by Shandong Provincial TCM Science and Technology Development Program Project,No.2019-0481Jining City Science and Technology Key Research and Development Program,No.2021YXNS069.
文摘BACKGROUND Percutaneous transluminal coronary angioplasty,while an effective intervention,can frequently lead to acute occlusion with severe consequences.Although clinical trials have demonstrated the efficacy of drug-coated balloons(DCB)in treating acute coronary artery occlusion and in preventing restenosis,there has been limited exploration on the use of DCB in treating de novo lesions in large vessels.Currently,DCB are only recommended for patients with small vessel lesions and in-stent restenosis lesions,those at high risk of bleeding,and other special groups of patients.CASE SUMMARY This report presents a case of successful drug-coated balloon treatment of de novo lesions in large coronary vessels.Postoperatively,the patient demonstrated favorable recovery,with subsequent examination results revealing no significant differences from the previous examination.CONCLUSION The successful treatment of the patient in our case highlights the potential of DCB in the treatment of de novo lesions in large coronary vessels.
基金sponsored by National Natural Science Foundation of China(No.82101389 and 81971114)Beijing Nova Program(No.20230484286)General Project of Science and Technology of Beijing Municipal Education Commission(No.KM202110025018).
文摘Objective:Early and accurate identification of large vessel occlusion(LVO)acute ischemic stroke(AIS)patients is critically important for stroke management.Practicable scales with simple items can facilitate prehospital paramedics distinguishing LVO-AIS patients with high efficiency and help to avoid unnecessary and costly delays.The current study aims to develop a screening tool to predict AIS-LVO patients based on prehospital available data.Method:A total of 251 suspected stroke patients who were transported to the emergency department of our hospital via emergency medical services were consecutively enrolled from August,2020 to January,2022.Data including demographic information,medical history,clinical manifestations,and vital signs were collected.A multivariate logistic regression model was developed based on statistically significant variables selected from univariate analysis.Result:Forty-two patients(16.7%)were diagnosed as LVO-AIS based on imaging validation at admission.A comprehensive model was developed with past medical history factors such as atrial fibrillation and coronary heart disease,vital signs such as systolic blood pressure,and prominent symptoms and signs such as gaze palsy,facial paralysis,and dysarthria.The model showed better diagnostic performance in terms of area under the receiver operating characteristic curves(0.884,95%CI,0.830-0.939),which was higher than other common prehospital prediction scales such as the Face,Arm,Speech,Time test(FAST),the Field Assessment Stroke Triage for Emergency Destination(FAST-ED)scale,and the Gaze-Face-Arm-Speech-Time test(G-FAST).Calibration curve analysis,decision curve analysis,and clinical impact curve analysis further validated the reliability,net benefit,and potential clinical impact of the prediction model,respectively.Conclusion:We conducted a prediction model based on prehospital accessible factors including past history of atrial fibrillation and coronary heart disease,systolic blood pressure,and signs such as gaze palsy,facial palsy,and dysarthria.The prediction model showed good diagnostic power and accuracy for identification of the high-risk patients with LVO and may become an effective tool for the LVO recognition in prehospital settings.Future studies are warranted to refine and validate the model further in order to enhance the accuracy and objectivity of clinical judgments.
文摘Objective:To investigate the clinical effects of applying the magnetic resonance double mismatch technique to endovascular treatment of acute anterior circulation,large vessel occlusion with cerebral infarction in an unknown time window.Methods:The research work was carried out in our hospital,the work was carried out from November 2018 to November 2019,the patients with acute anterior circulation large vessel occlusion with cerebral infarction who were treated in our hospital during this period,100 patients,50 patients with an unknown time window and 50 patients with definite time window were selected,and they were named as the experimental and control groups,given different examination methods,were given to investigate the clinical treatment effect.Results:Patients’data on HIHSS score before treatment,the incidence of intracranial hemorrhage and rate of Mrs≤2 rating after 90 days of treatment were not significantly different(P>0.05),which was not meaningful.The differences in data between the two groups concerning HIHSS scores were relatively significant before,and after treatment(P<0.05).Conclusion:The magnetic resonance double mismatch technique will be applied in the endovascular treatment of acute anterior circulation large vessel occlusion with cerebral infarction of unknown time window.
文摘Objective To summarize the clinical experience of frontotemporal expanded flap with bilateral superficial temporal vessels in repairing large area scar contracture in face and neck.Methods 14 patients with facial and Cervical scar contracture in our hospital were taken as the research object.With bilateral superficial temporal vessels as pedicles,a 400-600 ml skin dilator was inserted into the forehead and 50-100 ml skin dilator was inserted into the two temporal parts respectively.Within 3-4 months,the water injection volume reaches 2 times of the dilator volume.After maintaining for one month,skin flap transplantation was performed.The frontal flap was reserved for hairline reconstruction,and the flap was cut to cover the area after facial and Cervical scar release to reconstruct the jaw-neck angle.The pedicle division and pedicle trimming were performed 3-4 weeks after operation.Results All the 14 patients completed the operation successfully.The flap expansion time is 5-6 months.The expanded skin flap covers an area of 26 cm×9 cm-42 cm×16 cm,and all the skin flaps survived after operation.Among them,2 patients suffered from flap congestion after flap transplantation.Follow-up for 6-12 months showed that the color and texture of the skin flap were similar to those of facial skin,with natural transition and no obvious bloating.The angle between the lower jaw and the neck is about 90.The anterior flexion,posterior extension,lateral flexion and rotation of the neck are obviously improved compared with the anterior,and the posterior extension is close to normal.Conclusion Frontotemporal expanded flap with bilateral superficial temporal vessels is suitable for patients with large-area scar contracture in face and neck that cannot be repaired after expansion of adjacent local normal tissues.
基金supported by the Petrel Meteorological Observation Experiment Project of the China Meteorological Administration and the “Adaptive Improvement of New Observation Platform for Typhoon Observation (2018YFC1506401)” of the Ministry of Science and Technology。
文摘In collaboration with 12 other institutions, the Meteorological Observation Center of the China Meteorological Administration undertook a comprehensive marine observation experiment in the South China Sea using the Yilong-10 high-altitude large unmanned aerial vehicle(UAV). The Yilong-10 UAV carried a self-developed dropsonde system and a millimeter-wave cloud radar system. In addition, a solar-powered unmanned surface vessel and two drifting buoys were used. The experiment was further supported by an intelligent, reciprocating horizontal drifting radiosonde system that was deployed from the Sansha Meteorological Observing Station, with the intent of producing a stereoscopic observation over the South China Sea. Comprehensive three-dimensional observations were collected using the system from 31 July to2 August, 2020. This information was used to investigate the formation and development processes of Typhoon Sinlaku(2020). The data contain measurements of 21 oceanic and meteorological parameters acquired by the five devices, along with video footage from the UAV. The data proved very helpful in determining the actual location and intensity of Typhoon Sinlaku(2020). The experiment demonstrates the feasibility of using a high-altitude, large UAV to fill in the gaps between operational meteorological observations of marine areas and typhoons near China, and marks a milestone for the use of such data for analyzing the structure and impact of a typhoon in the South China Sea. It also demonstrates the potential for establishing operational UAV meteorological observing systems in the future, and the assimilation of such data into numerical weather prediction models.
文摘Background Whether intravenous thrombolysis(IVT)should be administered prior to endovascular therapy(EVT)in patients with atherothrombotic stroke-related large vessel occlusion(AT-LVO)remains unclear.This study aimed to assess the efficacy and safety of IVT administered before EVT in this patient population.Methods We analysed the data from a multicentre registry of patients who underwent EVT for AT-LVO.Patients were categorised based on presumed mechanism of occlusion:in situ occlusion(intracranial group)or embolism from cervical artery occlusion/stenosis(tandem group).We compared the efficacy and safety of IVT before EVT in patients who received IVT(IVT stratum)and those who did not(non-IVT stratum).The primary outcome was a modified Rankin Scale score of 0-2 at 90 days.Results Among the 336 patients in the intracranial group,99 patients underwent IVT.The rate of favourable functional outcomes did not differ between IVT and non-IVT strata(51.1%vs 47.6%;adjusted ORs(aORs)(95%CI),1.18(0.66 to 2.09));whereas any intracranial haemorrhage(ICH)(10.1%vs 3.8%;aOR,2.98(1.01 to 9.26))and mortality at 90 days(6.4%vs 1.3%;aOR,4.66(1.02 to 26.73))were significantly higher in the IVT stratum.Among the 233 patients in the tandem group,88 patients underwent IVT,with no significant differences in efficacy or safety outcomes between the strata.Conclusion In patients with AT-LVO,IVT before EVT did not improve outcomes and was associated with increased risk of ICH and mortality in those with in situ intracranial occlusion.IVT before EVT may not be recommended in patients with atherosclerotic intracranial occlusions.
