The Efficacy of Strokectomy in the Treatment of Malignant Cerebral Infarction Patients

Abstract IntroductionStrokectomy refers to the resection of infarct brain tissue. Used alone, in combination with decompressive hemicraniectomy (DHC), or as a remedial surgery to DHC for malignant cerebral infarction (MCI) patients, strokectomy has reduced mortality rates and improved functional outcomes of patients with MCI. However, the role of strokectomy in the treatment of MCI patients is controversial. The aim of this retrospective study was to investigate the efficacy of strokectomy in MCI treatment in order to explore its beneficial effects on improving patient outcomes.MethodsThis retrospective study was carried out between January 2017 and September 2019 in the First Affiliated Hospital of Jinan University and Guangdong 999 Brain Hospital in Guangzhou, China. We reviewed patients with MCI who underwent DHC with or without strokectomy. We collected and analyzed the following data for all patients: demographics, Glasgow Coma Scale scores (GCS), National Institutes of Health Stroke Scale (NIHSS) scores, observational data in the intensive care unit (ICU), post-surgery intracranial pressure (ICP) monitoring, midline shift before and after surgery, and functional outcomes measured with the modified Rankin Scale (mRS) at 6 months.ResultsWe recruited 95 patients (53 men; mean age, 59.71 ± 10.65 years; age range, 38 - 78 years). After surgery, patients who received DHC and strokectomy were associated with a lower ICP curve; decreased midline shift; and less mannitol, hypothermia, and hypertonic saline therapies than those who received DHC alone. No patient in the DHC+strokectomy group had malignant high ICP or needed remedial surgery; in contrast, 16 patients in the DHC group had malignant high ICP after DHC, and remedial surgery was recommended. Five patients received remedial surgery and survived, while the 11 who refused remedial surgery died. The mortality rate during ICU stay was 19.4% in the DHC group and 7.1% in the DHC+strokectomy group. While the rate of poor outcomes and mortality was significantly different between the two groups at 6 months after surgery, good outcomes did not differ significantly.Conclusions Strokectomy performed in combination with DHC can effectively decrease post-surgery ICP, reduce midline shift, and reduce mortality during the six months following surgery. Moreover, strokectomy performed as a remedial surgery could decrease malignant high ICP after DHC and reduce mortality.

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Effect of stress-induced hyperglycemia after non-traumatic non-aneurysmal subarachnoid hemorrhage on clinical complications and functional outcomes

10.21203/rs.3.rs-944631/v1 ◽

2021 ◽

Author(s):

Zeyu Zhang ◽

Yue Zhao ◽

Yibo Liu ◽

Xiaoyu Wang ◽

Houshi Xu ◽

...

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Cerebral Infarction ◽

Functional Outcomes ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Complication Rates ◽

Poor Outcome ◽

Clinical Complications ◽

Symptomatic Vasospasm ◽

Poor Outcomes

Abstract Background Despite having an overall benign course, non-traumatic non-aneurysmal subarachnoid hemorrhage (naSAH) is still accompanied by a risk of clinical complications and poor outcomes. Risk factors and mechanisms of complications and poor outcomes after naSAH remain unknown. Our aim was to explore the effect of stress-induced hyperglycemia (SIH) on complication rates and functional outcomes in naSAH patients. Methods We retrospectively reviewed patients with naSAH admitted to our institution between 2013 and 2018. SIH was identified according to previous criterion. Symptomatic vasospasm, delayed cerebral infarction, and hydrocephalus were identified as main complications. Outcomes were reviewed using a modified Rankin Scale (mRS) at discharge, 3 months, and 12 months. A statistical analysis of clinical, radiological, and laboratory risk factors of complications and outcomes was conducted. Results 244 naSAH patients were incorporated in the cohort with 74 (30.3%) SIH. After adjusting for age, gender, hypertension, Hunt and Hess (HH) grade, modified Fisher Scale (mFS), intraventricular hemorrhage (IVH), and subarachnoid blood distribution, SIH was significantly associated with symptomatic vasospasm (P < 0.001, 12.176 [4.904–30.231]), delayed cerebral infarction (P < 0.001, 12.434 [3.850-40.161]), hydrocephalus (P = 0.008, 5.771 [1.570-21.222]), and poor outcome at 12 months (P = 0.006, 5.506 [1.632–18.581]), whereas the correlation between SIH and poor outcome at discharge (P = 0.064, 2.409 [0.951-6.100]) or 3 months (P = 0.110, 2.029 [0.852–4.833]) was not significant. Incorporation of SIH increased the area under curve (AUC) of ROC in the combined model for predicting symptomatic vasospasm (P = 0.002), delayed cerebral infarction (P = 0.024), hydrocephalus (P = 0.037), and 12-month poor outcome (P = 0.087). Conclusions SIH is a significant and independent risk factor for symptomatic vasospasm, delayed cerebral infarction, hydrocephalus, and long-term poor outcome in naSAH patients. Identifying SIH early after naSAH is important for decision-making and treatment planning.

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Comparison of Clinical Efficacy Among Endoscopy-Assisted Radio-Frequency Ablation, Extracorporeal Shockwaves, and Eccentric Exercises in Treatment of Insertional Achilles Tendinosis

Journal of the American Podiatric Medical Association ◽

10.7547/14-146 ◽

2017 ◽

Vol 107 (1) ◽

pp. 11-16 ◽

Cited By ~ 5

Author(s):

Min Wei ◽

Yujie Liu ◽

Zhongli Li ◽

Zhigang Wang

Keyword(s):

Retrospective Study ◽

Radio Frequency ◽

Clinical Efficacy ◽

Radio Frequency Ablation ◽

Foot And Ankle ◽

Analog Scale ◽

Achilles Tendinosis ◽

Scale Scores ◽

Before And After ◽

American Orthopaedic

Background: We sought to compare clinical efficacy among endoscopy-assisted radio-frequency ablation under local anesthesia, extracorporeal shockwaves (ESWs), and eccentric exercises in treating insertional Achilles tendinosis. Methods: In this retrospective study, 78 patients diagnosed as having unilateral insertional Achilles tendinosis were enrolled. These participants underwent endoscopy-assisted radio-frequency ablation, ESWs, and eccentric calf muscle exercises between March 1, 2006, and February 28, 2011. Clinical efficacy was evaluated by the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot scale, and the Victorian Institute of Sport Assessment–Achilles (VISA-A) scale before and after treatment. Results: Before treatment, there were no statistically significant differences in VAS, AOFAS ankle/hindfoot scale, and VISA-A scale scores among the different groups (all P > .05). For the endoscopy and ESW groups, VAS, AOFAS ankle/hindfoot scale, and VISA-A scale scores were significantly improved after 18 months of treatment (all P < .05). The VAS, AOFAS ankle/hindfoot scale, and VISA-A scale scores in the endoscopy group were significantly higher than those in the ESW and eccentric exercise groups after 18 months of therapy (all P < .05). Conclusions: Combined with synovectomy and tendon debridement, endoscopy-assisted radio-frequency ablation yields better clinical efficacy compared with ESWs in treating insertional Achilles tendinosis.

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Abstract TP309: Subarachnoid Extension of Hemorrhage Is Associated with Poor Outcomes in Primary Intracerebral Hemorrhage

Stroke ◽

10.1161/str.44.suppl_1.atp309 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Matthew B Maas ◽

Alexander J Nemeth ◽

Neil F Rosenberg ◽

Adam R Kosteva ◽

James C Guth ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcomes ◽

Regression Models ◽

Scale Scores ◽

Unknown Significance ◽

Clinical Consequences ◽

Lobar Hemorrhage ◽

Underlying Mechanisms ◽

Poor Outcomes ◽

Ich Score

Background: Extension of hemorrhage into the subarachnoid space is observed in primary intracerebral hemorrhage (ICH), yet the phenomenon has undergone limited study and is of unknown significance. The objective of this study is to evaluate the incidence, characteristics and clinical consequences of subarachnoid hemorrhage extension (SAHE) in ICH. Methods: Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. Patients were managed, and serial neuroimaging obtained, per a structured protocol. SAHE was identified on imaging, along with ICH volumes, by expert reviewers blinded to outcomes. Ordinal regression models were developed to test whether the occurrence of SAHE was a predictor of functional outcomes independent of ICH Score, with confirmation of model validity by appropriate tests. Results: 234 patients were studied, and 93 (39.7%) had SAHE. SAHE was associated with lobar hemorrhage location (65% of SAHE versus 19% of non-SAHE cases, p<0.001), and larger hematoma volumes (median 23.8 versus 6.65, p<0.001). SAHE was a predictor of higher modified Rankin Scale scores (mRS) at discharge (odds ratio 2.22 per mRS point [95% CI 1.29-3.81]) and 28 days (1.80 [1.04-3.11]) after adjustment for ICH Score. Conclusions: SAHE is associated with poor outcomes independent of traditional ICH severity measures. Further exploration of this phenomenon to understand the underlying mechanisms of harm is needed.

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Comparison of multimodal intra-arterial treatment versus intravenous thrombolysis for hypertensive patients with severe large vessel cerebral infarction

Journal of Investigative Medicine ◽

10.1136/jim-2016-000164 ◽

2017 ◽

Vol 65 (7) ◽

pp. 1033-1040 ◽

Cited By ~ 1

Author(s):

Zuojun Tian ◽

Geng Liao ◽

Shaoming Li ◽

Yuechun Shen ◽

Changbing Chen ◽

...

Keyword(s):

Cerebral Infarction ◽

Functional Outcomes ◽

Intravenous Thrombolysis ◽

Functional Independence ◽

Hemorrhagic Transformation ◽

Large Vessel ◽

Hypertensive Patients ◽

Group Outcomes ◽

Proximal Middle Cerebral Artery ◽

Poor Outcomes

Since intravenous thrombolysis (IVT) is often associated with poor outcomes in hypertensive patients with severe acute cerebral infarction (ACI) due to occlusions of the internal carotid, basilar, or proximal middle cerebral artery, we evaluated whether multimodal intra-arterial treatment (IAT) might improve functional outcomes in this patient population. We retrospectively reviewed the charts of eligible patients who underwent multimodal IAT including intra-arterial thrombolysis, mechanical thrombectomy, balloon and/or stent angioplasty (IAT group) or IVT alone (IVT group). Outcomes included the revascularization rate 24 hours postprocedure, the frequency of survival at 7, 90, and 180 days postonset, and a measure of functional outcomes using the modified Rankin Scale (mRS). The IAT group included 62 patients and the IVT group included 31 patients. Multimodal IAT increased the revascularization rate at 24 hours (p<0.001) and the frequency of survival and functional independence (mRS ≤2) at 7 days (p<0.001 and p=0.018, respectively), 90 days (both p<0.001), and 180 days (both p<0.001). Independent predictors of longer survival were treatment with multimodal IAT (HR 0.1; 95% CI 0.0 to 0.4; p<0.001) and revascularization (HR 0.1; 95% CI 0.0 to 0.4; p<0.001), whereas a longer duration from onset to treatment was a risk factor for death (HR 1.4; 95% CI 1.2 to 1.8; p<0.001). There was no significant between-group difference for symptomatic hemorrhagic transformation. This study found that for patients with severe hypertensive ACI with large vessel occlusions, multimodal IAT improved the outcomes, including early revascularization, survival, and functional outcome.

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Beneficial Effects of Akkermansia muciniphila Are Not Associated with Major Changes in the Circulating Endocannabinoidome but Linked to Higher Mono-Palmitoyl-Glycerol Levels as New PPARα Agonists

Cells ◽

10.3390/cells10010185 ◽

2021 ◽

Vol 10 (1) ◽

pp. 185

Author(s):

Clara Depommier ◽

Rosa Maria Vitale ◽

Fabio Arturo Iannotti ◽

Cristoforo Silvestri ◽

Nicolas Flamand ◽

...

Keyword(s):

Metabolic Syndrome ◽

Univariate Analysis ◽

Metabolic Effects ◽

Peroxisome Proliferator ◽

Peroxisome Proliferator Activated Receptor ◽

Akkermansia Muciniphila ◽

Beneficial Effects ◽

Daily Ingestion ◽

Before And After ◽

Palmitoyl Glycerol

Akkermansia muciniphila is considered as one of the next-generation beneficial bacteria in the context of obesity and associated metabolic disorders. Although a first proof-of-concept of its beneficial effects has been established in the context of metabolic syndrome in humans, mechanisms are not yet fully understood. This study aimed at deciphering whether the bacterium exerts its beneficial properties through the modulation of the endocannabinoidome (eCBome). Circulating levels of 25 endogenous endocannabinoid-related lipids were quantified by liquid chromatography with tandem mass spectrometry (LC-MS/MS) in the plasma of overweight or obese individuals before and after a 3 months intervention consisting of the daily ingestion of either alive or pasteurized A. muciniphila. Results from multivariate analyses suggested that the beneficial effects of A. muciniphila were not linked to an overall modification of the eCBome. However, subsequent univariate analysis showed that the decrease in 1-Palmitoyl-glycerol (1-PG) and 2-Palmitoyl-glycerol (2-PG), two eCBome lipids, observed in the placebo group was significantly counteracted by the alive bacterium, and to a lower extent by the pasteurized form. We also discovered that 1- and 2-PG are endogenous activators of peroxisome proliferator-activated receptor alpha (PPARα). We hypothesize that PPARα activation by mono-palmitoyl-glycerols may underlie part of the beneficial metabolic effects induced by A. muciniphila in human metabolic syndrome.

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The Dose of Somatostatin Analogues during Pre-Surgical Treatment Is a Key Factor to Achieve Surgical Remission in Acromegaly

Endocrines ◽

10.3390/endocrines2030023 ◽

2021 ◽

Vol 2 (3) ◽

pp. 241-250

Author(s):

Marta Araujo-Castro ◽

Eider Pascual-Corrales ◽

Héctor Pian ◽

Ignacio Ruz-Caracuel ◽

Alberto Acitores Cancela ◽

...

Keyword(s):

Retrospective Study ◽

Surgical Treatment ◽

Surgical Outcomes ◽

Pituitary Adenomas ◽

Somatostatin Analogues ◽

Beneficial Effects ◽

Key Factor ◽

Long Acting ◽

First Time ◽

Endocrine Complications

Purpose: to determine whether pre-surgical treatment using long-acting somatostatin analogues (SSAs) may improve surgical outcomes in acromegaly. Methods: retrospective study of 48 patients with acromegaly operated by endoscopic transsphenoidal approach and for first time. Surgical remission was evaluated based on the 2010 criteria. Results: most patients, 83.3% (n = 40), harbored macroadenomas and 31.3% (n = 15) invasive pituitary adenomas. In this case, 14 patients were treated with lanreotide LAR and 6 with octreotide LAR, median monthly doses of 97.5 [range 60–120] and 20 [range 20–30] mg, respectively, for at least 3 months preoperatively. Presurgical variables were comparable between pre-treated and untreated patients (p > 0.05). Surgical remission was more frequent in those pre-treated with monthly doses ≥90 mg of lanreotide or ≥30 mg of octreotide than in untreated or pre-treated with lower doses (OR = 4.64, p = 0.025). However, no differences were found between pre-treated and untreated patients when lower doses were included or between those treated for longer than 6 months compared to those untreated or pre-treated for shorter than 6 months. Similarly, no differences were found either in terms of surgical or endocrine complications (OR = 0.65, p = 0.570), independently of the doses and the duration of SSA treatment (p > 0.05). Conclusions: the dose of SSAs is a key factor during pre-surgical treatment, since the beneficial effects in surgical remission were observed with monthly doses equal or higher than 90 mg of lanreotide and 30 mg of octreotide, but not with lower doses.

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Reduction in mobility and COVID-19 transmission

Nature Communications ◽

10.1038/s41467-021-21358-2 ◽

2021 ◽

Vol 12 (1) ◽

Cited By ~ 7

Author(s):

Pierre Nouvellet ◽

Sangeeta Bhatia ◽

Anne Cori ◽

Kylie E. C. Ainslie ◽

Marc Baguelin ◽

...

Keyword(s):

Predictive Ability ◽

Control Measures ◽

Social Distancing ◽

Beneficial Effects ◽

Mobility Data ◽

Strict Control ◽

Before And After ◽

Proxy Measure ◽

Lower Transmission ◽

The Relationship

AbstractIn response to the COVID-19 pandemic, countries have sought to control SARS-CoV-2 transmission by restricting population movement through social distancing interventions, thus reducing the number of contacts. Mobility data represent an important proxy measure of social distancing, and here, we characterise the relationship between transmission and mobility for 52 countries around the world. Transmission significantly decreased with the initial reduction in mobility in 73% of the countries analysed, but we found evidence of decoupling of transmission and mobility following the relaxation of strict control measures for 80% of countries. For the majority of countries, mobility explained a substantial proportion of the variation in transmissibility (median adjusted R-squared: 48%, interquartile range - IQR - across countries [27–77%]). Where a change in the relationship occurred, predictive ability decreased after the relaxation; from a median adjusted R-squared of 74% (IQR across countries [49–91%]) pre-relaxation, to a median adjusted R-squared of 30% (IQR across countries [12–48%]) post-relaxation. In countries with a clear relationship between mobility and transmission both before and after strict control measures were relaxed, mobility was associated with lower transmission rates after control measures were relaxed indicating that the beneficial effects of ongoing social distancing behaviours were substantial.

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Elevated Endostatin Expression Is Regulated by the pIgA Immune Complex and Associated with Disease Severity of IgA Nephropathy

Kidney & Blood Pressure Research ◽

10.1159/000508079 ◽

2020 ◽

pp. 1-13

Author(s):

Yaling Zhai ◽

Xiaoqing Long ◽

Jingge Gao ◽

Xingchen Yao ◽

Xinnian Wang ◽

...

Keyword(s):

Iga Nephropathy ◽

Disease Severity ◽

Immune Complex ◽

Poor Prognosis ◽

High Serum ◽

Endothelial Cell Proliferation ◽

Renal Interstitium ◽

Before And After ◽

Poor Outcomes

Background/Aims: Renal vascular injury accounts for the poor outcomes of patients with IgA nephropathy (IgAN). In this study, we investigated whether endostatin, a potent inhibitor of angiogenesis, is associated with IgAN. Methods: Serum endostatin levels were detected in patients with IgAN, disease controls, and healthy controls, and the correlation among endostatin and clinicopathologic manifestations, as well as prognosis in patients with IgAN, was analyzed. In addition, serum endostatin levels were compared in patients “before” and “after” treatment. Data on endostatin expression in the renal interstitium of patients with IgAN were downloaded and analyzed from the GSE35489 array in the GEO database. The poly-IgA1 (pIgA) immune complex is widely recognized as the “trigger” of IgAN initiation. pIgA in the plasma of patients was extracted and used to stimulate human glomerular endothelial cells (GECs). Endostatin, IL-6, and CXCL1 in the cell supernatant were detected by ELISA kits. Results: We found that serum endostatin levels were significantly increased in patients with IgAN, as was endostatin expression in the renal interstitium. Patients with IgAN were divided into 2 groups according to the median value. The high endostatin expression group had significantly higher levels of serum creatinine and BUN and more severe tubular/interstitial damage. Moreover, patients with arteriolar injury and endothelial cell proliferation had higher serum endostatin levels. Patients with high serum endostatin levels had poor prognosis. According to the in vitro experiment, the GEC apoptosis rate and the supernatant levels of endostatin, IL-6, and CXCL1 were significantly increased following pIgA stimulation. Conclusion: Our study found that elevated endostatin expression was associated with disease severity and poor prognosis in patients with IgAN and can be upregulated by pIgA, but how it participates in the pathogenesis of IgAN deserves further exploration.

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Double Rectangle Fascia Lata Frontalis Sling: A Rationale Approach for Ptosis

Indian Journal of Plastic Surgery ◽

10.1055/s-0041-1723909 ◽

2021 ◽

Vol 54 (01) ◽

pp. 058-062

Author(s):

Pawan Agarwal ◽

Dhananjaya Sharma ◽

Vikesh Agrawal ◽

Swati Tiwari ◽

Rajeev Kukrele

Keyword(s):

Retrospective Study ◽

Surgical Outcomes ◽

Functional Outcomes ◽

Fascia Lata ◽

Modified Technique ◽

Eyelid Margin ◽

Upper Eyelid ◽

Light Reflex ◽

Straight Line

AbstractBackground The purpose of this study was to evaluate the functional outcomes of a modified technique of double rectangle pattern for correction of severe ptosis.Methods This is a retrospective study over a period of 8 years including patients who underwent correction of ptosis by double rectangle using autologous fascia lata sling. Surgical outcomes were assessed postoperatively by distance from the corneal light reflex to the upper eyelid margin (MRD1) and levator function.Results Twenty-six eyelids were operated in 20 patients. There were 9 males and 11 females, with age ranging from 4 to 35 years. Preoperatively, all patients had poor MRD1 and poor levator function. Postoperative MRD1 was good in 13 patients (17 eyelids), fair in 5 (7eyelids), and poor in 2 patients (2 eyelids). Postoperative levator function was excellent in 12 patients (15 eyelids), good in 6 (9 eyelids), and fair in 2 patients (2 eyelids). At a mean follow-up of 12 months, adequate correction was achieved in 24 eyelids, and 2 eyelids had undercorrection.Conclusion Frontalis sling with a double rectangle is simple and more efficient, as it provides a straight line of pull to the eyelid for correction of severe ptosis.

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Subtle changes of the crystalline lens after cycloplegia: a retrospective study

BMC Ophthalmology ◽

10.1186/s12886-021-01884-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Cheng Dai ◽

Meng Liu ◽

Xiaodong Lv ◽

Binzhong Li

Keyword(s):

Retrospective Study ◽

Children And Adolescents ◽

Population Change ◽

Anterior Segment ◽

Anterior Chamber Depth ◽

Crystalline Lens ◽

Equivalent Diameter ◽

Crystalline Morphology ◽

Significant Difference ◽

Before And After

Abstract Background The purpose of this study was to evaluate the shape of the crystalline lens in terms of biometry and diopters before and after cycloplegia using the CASIA2 swept-source (SS) optical coherence tomography (OCT) system on the anterior segment. Methods This was a retrospective study. Children and adolescents (26 males and 29 females, aged 4–21 years) with simple ametropia were selected for optometry and CASIA2 imaging at 2 separate visits before and after cycloplegia. Diopter values were derived from the spherical power (S) obtained by optometry. Biometric parameters of the crystalline lens, including the anterior chamber depth (ACD), anterior and posterior curvature of the lens (ACL and PCL), lens thickness (LTH), lens decentration (LD), lens tilt (LT), and equivalent diameter of the lens (LED), were measured by the CASIA2 system. The differences in these parameters after compared with before cycloplegia were determined, and their relationships were analyzed. Results Fifty-five participants (106 eyes) were initially enrolled. There was a significant difference (P < 0.05) in the S (t=-7.026, P < 0.001), ACD (t=-8.796, P < 0.001), ACL (t=-13.263, P < 0.001) and LTH (t = 7.363, P < 0.001) after compared with before cycloplegia. The change in the PCL (t = 1.557, P = 0.122), LD (t = 0.876, P = 0.383), LT (t = 0.440, P = 0.661) and LED (t=-0.351, P = 0.726) was not statistically significant (P > 0.05). There was a significant (P < 0.05) correlation of the change in the S with that in the ACL (r = 0.466, P < 0.001), LTH (r=-0.592, P < 0.001), and LED (r = 0.223, P = 0.021) but not the PCL (r = 0.19, P = 0.051), LD (r=-0.048, P = 0.0628) or LT (r=-0.022, P = 0.822). Furthermore, the change in the ACD was closely related to the change in crystalline morphology. However, in children and adolescents, we found that the change in crystalline morphology was unrelated to age. Conclusions Changes in lens morphology after compared with before cycloplegia are mainly related to the ACL and LTH, but there is no difference in the PCL, LD, LT, or LED. In the adolescent population, change in the S is related to change in the ACL, LED and LTH. However, age is unrelated to the shape and tendency of the crystalline lens. Further research is required to determine whether the same conclusion applies to different age groups and different refractive states (myopia, hyperopia, emmetropia) .

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