Volume 99 ·  Issue 39 ·  2019

Cardiovascular and cerebrovascular diseases account for more than 40% of Chinese deaths, which is higher than tumors and other diseases. The prevention and treatment of cardiovascular and cerebrovascular diseases has always been the focus of medical and health security in China. The causes of cardiovascular and cerebrovascular diseases are homogeneous. However, the excessive refinement of modern medical profession and the separate prevention and treatment of cardiovascular and cerebrovascular diseases lead to a waste of medical resources. Therefore, it is necessary to establish a new discipline of brain and heart treatment.

Comorbid brain and heart diseases are a group of diseases that seriously threaten the health of residents in China, and have become a major public health problem. Further reduce the prevalence and mortality of cerebral cardiovascular diseases, adhere to people's health as the center, give full play to the existing resource advantages of cerebrovascular diseases and cardiovascular diseases, establish a working system of "brain-heart co-treatment, brain-heart co-research, brain-heart co-prevention, brain-heart co-health, and Chinese and western use" (referred to as "Five Tongs" for short), and practice the concept of building a system of brain-heart co-occurring diseases. The risk factors of brain-heart co-occurring diseases are effectively controlled, and the whole population and life cycle health management are realized. Achieve the strategic goal of Healthy China Action: by 2022 and 2030, the mortality rate of cardiovascular and cerebrovascular diseases will decrease by 209.7/100,000 and below and by 190.7/100,000 and below, respectively.

There are many diagnostic methods for chronic venous disease. Take varicose veins of the lower limbs as an example. According to the clinical manifestations, the diagnosis is not difficult, but necessary examinations are needed to clarify the deep and superficial veins and penetrating veins of the lower limbs in order to make an exact diagnosis.

To investigate the Association between soluble receptor for advanced glycation end products (sRAGE) and coronary and cerebral atherosclerosis.

A total of 232 consecutive patients who synchronously undertook coronary angiography and craniocerebral CT angiography (or total cerebral angiography) were included between May 2018 and December 2018 in Beijing Tiantan Hospital, Capital Medical University in this study. Patients were divided into the control group (without coronary artery disease (CAD) and cerebrovascular stenosis (CVS), n=55), CAD group (n=118), CVS group (n=11), concomitant CAD and CVS group (CAD+CVS, n=48). Plasma sRAGE level was measured by enzyme-linked immunosorbent assay (ELISA) and compared among the four groups. The relationship between sRAGE and Gensini Score (GS) and cerebrovascular stenosis severity was assayed. sRAGE levels were compared among low, middle and high GS group as well as between extracranial and intracranial arteries stenosis.

The levels of sRAGE in CAD group (1.96 μg/L) were higher than those in the control group (1.66 μg/L, P=0.025) or the CVS group (1.53 μg/L, P=0.013). However, no significant difference in sRAGE level was found between the groups of CAD and CAD+CVS (1.89 μg/L, P>0.05). Meanwhile, sRAGE was positively associated with GS in the entire study population (r=0.153, P=0.023) or in the diabetic patients (r=0.242, P=0.017). The sRAGE leves in both middle GS and high GS groups were higher than those in low GS group (P<0.05). No association between sRAGE and CVS severity and vascular count. Additionally, no significant difference in levels of sRAGE was found between extracranial (1.84 μg/L) and intracranial arteries stenosis (1.66 μg/L, P=0.523).

Plasma sRAGE level is positively associated withseverity of CAD, but its association with cerebral atherosclerosis needs further studies.

To investigate the safety and efficacy of mechanical thrombectomy in patients with atrial fibrillation complicated with acute intracranial arterial occlusion.

Fifty-eight patients with atrial fibrillation complicated with acute intracranial arterial occlusion in the intervention group of East (Endovascular Therapy for Acute ischemic Stroke Trial) were analyzed. According to the TOAST (Trial of Org 10 172 in Acute Stroke Treatment) classification, patients were divided into ICAS (Intracranial Atherosclerotic Stenosis) group and cardiogenic embolism group. Clinical characteristics, treatment methods and clinical prognosis were compared between ICAS group and cardiogenic embolism group.

A total of 58 patients with atrial fibrillation complicated with acute intracranial arterial occlusion were included in this study, including 46 patients in the cardiogenic embolism group (79%) and 12 patients in the ICAS group (21%). The pre-hospital transport time in ICAS group was longer than that in cardiogenic embolism group (P<0.05).Patency rate in patients with atrial fibrillation complicated with acute intracranial arterial occlusion was 98.3% (57/58), The rate of patients with the 90-day function independent (mRS 0-2) was 51.7% (30/58). There were no statistically significant differences in functional independence, mortality rate, ICH and sICH at 90 days between the cardiogenic embolism group and the ICAS group.

Mechanical thrombectomy is an effective method to treat patients with atrial fibrillation complicated with acute intracranial arterial occlusion.

To study the safety of dual antiplatelet therapy prior to carotid endarterectomy in the patients with carotid artery stenosis and Coronary Artery Accident.

We review 86 patients with carotid artery stenosis and Coronary Artery Accidents who admitted in Peking University International Hospital between 2017 January and 2019 March. The 86 patients undergo carotid endarterectomy with dual antiplatelet therapy. We evaluate the safety of carotid endarterectomy dunring the dual antiplatelet thrapy by analyzing the incidence of acute coronary syndrome, ischemic cerebrovascular accident, intracranial hemorrhage, and regional hematoma.

From 2017 January to 2019 March, 86 patients with carotid artery stenosis and Coronary Artery Accident continued dual antiplatelet therapy prior to carotid endarterectomy. The incidence of main perioperative complications were as follows: acute coronary syndrome: 0; asymptomatic ischemia cerebrovascular accident: 8.1% (7/86); symptomatic ischemia cerebrovascular accident: 0; intracranial hemorrhage:0; neck hematoma:13.9%(13/86). All the patients were followed 30 days after the procedure. The modify Rakin Scale of the patients were all <3. The local hematoma were all recovered automatically without treatment and the perioperative mortality and morbidity was 0.

For the patients with carotid artery stenosis and Coronary Artery Accidents, carotid endarterectomy under dual antiplatelet therapy was a safe choice.

To implement simultaneous treatments in patients with severe carotid artery stenosis and coronary artery disease (CAD), we sought to investigate its efficacy of reducing perioperative major adverse cardiac and cerebrovascular event (MACCE).

Brain-and-Heart treatment team in Peking University International Hospital performed hybrid Digital Substraction Angiography (DSA) of carotid artery and coronary artery for 37 patients meeting the group criterion from September 2017 to February 2019.Twelve patients were diagnosed and received simultaneous treatments of severe carotid artery stenosis and coronary artery disease after hybrid DSA. We conducted the retrospective study and made analysis of these patients.

The diagnosis rate by simultaneous treatmentsin patients with carotid artery stenosis and coronary artery disease is 59.5% (22/37), the rate of severe carotid artery stenosis or multi-vessel CAD is 77.3% (17/22).The rate of severe carotid artery stenosis with CAD is 54.5% (12/22), therate of simultaneous treatmentsis 83.3%(10/12). Nine patients post-operative symptoms release, one patient with ischemic stroke after CABG, and two patients of medical therapy with stable symptoms.

Simultaneous treatments in patients with severe carotid artery stenosis and coronary artery disease not only reveal the positive correlation between carotid stenosis and CAD, but also accurately evaluate severity degree or rapidly formulate scheme and reduce MACCE.

To evaluate the safety and clinical value of combined cardiac and cerebral angiography in the diagnosis and treatment of patients with carotid artery stenosis.

Clinical data of patients from May 2016 to June 2019 were collected. The patient underwent combined angiography under local anesthesia. Clinical characteristics, prognosisand complications were retrospectively analyzed.

A total of 45 patients with carotid artery stenosis received combined angiography, among which 12 patients had no obvious carotid artery stenosis. There were 22 cases with unilateral carotid artery stenosis, including 12 cases with mild stenosis and 10 cases with moderate to severe stenosis. There were 11 cases of bilateral stenosis, including 3 cases with mild stenosis and 8 cases with moderate to severe stenosis. 12 patients had no obvious stenosis incoronary arteries, 11 patients had single-vessel disease, 7 patients had 2-vessel disease, and 15 patients had 3-vessel disease. In the whole group of patients, surgical indications are available of 18 patients with carotid artery stenosis, 4 of the mreceived combined therapy. 2 of them under went Carotid Endarterectomy (CEA)+Percutaneous Transluminal Coronary Intervention (PCI), 2 under went Carotid Artery Stenting (CAS)+PCI. CAS+coronary artery angiography was performed in 3 cases. CEA+coronary angiography was performed in 5 cases. 5 patients received conservative treatment after combined angiography. In one case, the condition of coronary artery was so complicated that PCI was performed firstly. No cardiac or cerebrovascular complications such as myocardial infarction or cerebral infarction occurred during perioperative period.

Combined cardio-cerebrovascular angiography is a good method to evaluate the cardiovascular and cerebrovascular in the diagnosis and treatment of patients with carotid artery stenosis, which can provide a clear diagnosis for treatment with a low complications frequency.

The optimal operative strategy in patients with asymptomatic severe carotid artery stenosis undergoing coronary artery bypass grafting (CABG) is unknown. We sought to investigate the safety of carotid arterial shunting during simultaneous CABG and carotid endarterectomy (CEA).

The clinical data of patients undergoing synchronous combined CEA and CABG in the First Hospital of China Medical University between March 2017 and July 2019 was retrospectively studied. Patients with asymptomatic severe carotid artery stenosis ≥70% according to NASCET (North American Symptomatic Carotid Endarterectomy Trial) were required CABG surgery. During conventional CEA, carotid arterial shunting was used in all cases.

Ten patients were recruited. The average clamping time of carotid artery was 5 minutes. The average follow-up time was 10 months. We did not observe stroke, cerebral hyper perfusion syndrome, death and carotid restenosis.

Carotid arterial shunting during synchronous combined CEA and CABG was helpful for obtaining good curative effect.

To evaluate the clinical values of 4 types of ceramides (Cer1, Cer2, Cer3, Cer4) in the coronary artery stenosis, clinical diagnosis and risk prediction.

A total of 890 patients with coronary heart disease (CHD) in Beijing Anzhen Hospital between March 2018 and August 2018 were enrolled. The relationships between different degrees of coronary artery stenosis and ceramide levels was investigated. Diagnostic value of ceramides on acute myocardial infarction was analyzed. Meanwhile, Major adverse cardiac and cerebrovascular events (MACCE) in 1 year after discharging were collected to evaluate the predictive value of ceramides on risk of CHD and stroke.

This study showed that there were no significant differences of ceramide levels in CHD patients with different degrees of coronary artery stenosis (P>0.05), and the area under receiver operating characteristic (ROC) curve in the diagnosis of acute myocardial infarction patients was 0.725.

Ceramide is proved to be helpful in the diagnosis of acute myocardial infarction and MACCE prediction. The relationships between ceramide and degrees of coronary artery stenosis as well as the prognosis of CHD need further elucidation.

To reconstruct a 3D model from adult femur CT scan data and automate a measurement of femoral anatomical parameters to study the characteristics of Chinese femur anatomical parameters.

Using Mimics17.0, models from the CT data of 148 adult patients were established. The completed model was imported into Geomagic Studio and the anatomical landmarks of the femur were extracted to establish 3D coordinate system and unified coordinate system. Programmed with Matlab, using the nearest point iterative ICP algorithm and the 3D automatic extraction algorithm of anatomical landmarks to provide precision positioning, the femoral anatomical parameters were automatically measured and analyzed. The data were compared by using independent sample t test.

In this group, the diameter of the male femoral condyle was (84.1±3.6) mm, and it was (74.8±3.3) mm in the female; the anteroposterior diameter of the male femoral condyle was (66.5±3.7) mm, and it was (61.2±3.5) mm in the female; the diameter of the male ball head was (48.8±2.1) mm and it was (43.4±2.2) mm in the female; the differences between the two genders were all statistically significant (t=16.21, 8.84, 15.20, all P<0.05). The male femoral moment radius was (112.5±24.5) mm, and it was (124.7±19.2) mm in the female (t=3.30, P=0.002). The neck angle in male participants was 124.9°±4.0°, and it was 126.1°±5.5° in the female (t=1.40, P>0.05). As the height growed, most of the anatomical parameters increased accordingly.

The 3D automatic measurement of femoral anatomical parameters is more reproducible and accurate than manual measurement. It is necessary to establish and enrich the femoral anatomical database to design and develop internal fixation products that meet the needs of Chinese people.

To evaluate the efficacy and safety of an intraoperative betamethasone periarticular injection in patients undergoing primary unicompartmental knee arthroplasty (UKA).

Seventy patients with knee anteromedial osteoarthritis who underwent the primary unilateral UKA in China-Japan Friendship Hospital from July 2017 to October 2018 were randomized into two groups with random number table. In the group A, an analgesic mixture of morphine, ropivacaine, epinephrine, ketorolac and betamethasone was infiltrated intraoperatively into the soft tissue. While in the group B, a same volume of mixture without betamethasone was injected alternatively. The visual analogue scale (VAS) of pain and analgesic consumption were evaluated to compare the effectiveness of pain control between the two groups. In addition, maximal flexion of the knee andinitial time of the straight leg raising were monitored. Complications were assessed too. The data were compared with independent-sample t test.

No significant differences in VAS score was found between the groups at 6 h and 12 h after the operation (t=-1.154, -1.108, both P>0.05), but the pain level and analgesic consumption were significantly lower in the group A from 18 h to 72 h post operation (t=-2.959, -2.808, -2.080, -2.519, -3.378, -3.237, all P<0.05). The maximal flexion in group A was significantly higher than that in the group B from 1 d to 3 d (t=2.985, 4.575, 4.013, all P<0.05). The straight leg raising ability and incidence of complications were similar between the groups (χ²=0.141, 0.000, both P>0.05).

The cocktail analgesics injection containing small dose of betamethasone during UKA can provide effective acute pain control early after the surgery, which is conducive to knee joint function, and it does not increase the incidence of postoperative complications.

To investigate the value of quantitative and semiquantitative parameters of DCE-MRI in predicting IDH gene mutation of high-grade gliomas before the operation.

Twenty-six individuals with surgically and pathologically proved WHO Ⅲ-Ⅳ gliomas collected from April 2016 to June 2019 in First People′s Hospital of Changzhou, were divided into two groups, IDH mutation group (7 cases, 27-67 years, 3 males and 4 females,) and IDH gene wild group (19 cases, 42-75 years, 12 males and 7 females) according to the results of molecular pathology. All individuals underwent conventional plain (T₁WI, T₂WI), enhanced MR scanning (T₁WI) and dynamic contrast enhancement (DCE). Four quantitative parameters:volume transfer constant (K^trans), ratio constant of back flux (Kep), extravascular extracellular space fractional volume (Ve), and blood plasma fractional volume (Vp), and four semiquantitative parameters: time to peak (TTP), maximum concentration (MAX Conc), initial area under the gadolinium concentration-time curve (IAUC) and maximum slope of decrease (MAX Slope) were measured. The independent samples t test (normal distribution and homogeneity of variance) or Mann-Whitney rank sum test (abnormal distribution or heterogeneity of variance) were used to compare the differences of quantitative and semiquantitative parameters between IDH gene mutation group and IDH gene wild type group. Receiver operating characteristic (ROC) curve was used to evaluate the efficiency of quantitative and semiquantitative parameters in predicting IDH gene mutation of high-grade gliomas.

The value of K^trans,TTP in IDH mutated group were 0.096 (0.080,0.135)/min and (3.95±0.34) s, respectively. The value of K^trans, TTP in IDH wild type group were 0.168 (0.132, 0.337)/min and (2.58±1.15) s, respectively. The value of K^trans in IDH mutated group was significantly less than the value of K^trans in IDH gene wild type group (Z value was -2.168, P value was 0.030). The value of K^trans in IDH mutated group was significantly greater than the value of K^trans in IDH gene wild type (Z value was -2.630, P value was 0.007). The area under the ROC curve (AUC) of K^trans and TTP in predicting IDH gene mutation of high-grade gliomas was 0.782 and 0.842, respectively. The specificity of K^trans was higher (73.7%), The sensitivity of TTP was the higher (100.0%). Combined K^transand TTP were the best for predicting IDH gene mutation of high-grade gliomas, AUC was 0.865.

Quantitative and semiquantitative parameters of DCE-MRI can help to predict IDH gene mutation of high-grade gliomas before the operation.

To explore the diagnostic efficiency of digital breast tomosynthesis (DBT) for mass lesions in dense breast by comparing with digital mammography (DM).

A retrospective analysis was made of 125 female patients with breast masses confirmed by pathology in the First Affiliated Hospital of Jinzhou Medical University from June 2018 to April 2019, all of whom were dense breast. Pathological results were taken to compare the diagnostic value of DM, DBT and the combination of the two for breast mass lesions.

The overall detection rates of DM, DBT and their combination were 77.6% (97/125), 88.8%(111/125) and 92.8%(116/125) in dense breast. The detection rates of burr sign and lobulation sign by DM and DBT in malignant tumors were 39.7%(31/78), 60.3%(47/78) and 48.7%(38/78), 67.9%(53/78), respectively, with statistically significant differences (all P<0.05). The sensitivity of DM, DBT and their combination in differentiating benign from malignant breast mass lesions of dense breast was 75.6% (59/78), 83.3%(65/78), 93.6%(73/78), the specificity was 63.8%(30/47), 80.9% (38/47), 76.6%(36/47),and the area under ROC curve(AUC) was 0.697, 0.821 and 0.852, respectively.

DBT is more effective than DM in the diagnosis of dense breast mass lesions, and the combination of DBT and DM is more significant.

Multiple intracranial aneurysm caused by myxoma is a rare disease, and its epidemiological characteristics and pathogenesis are still unclear. Therefore, there are many controversies in clinical treatment decision-making and there is no clear optimal treatment plan. Two cases of multiple intracranial aneurysms caused by atrial myxoma were reported to explore the clinical prognosis and the best treatment decision of multiple intracranial aneurysms caused by atrial myxoma.

To investigate the clinical manifestations, imaging characteristics and bacteriological characteristics of patients with infectious endocarditis complicated with brain abscess. The causes, clinical manifestations, imaging characteristics and bacteriological characteristics of 2 patients with infectious endocarditis complicated with brain abscess were analyzed and summarized. Two patients with infectious endocarditis complicated with brain abscess had fever as the first symptom, and the clinical manifestations were headache and limb disorders. The lesion was single, and the abscess was found in the frontal and occipital lobes of the brain. Staphylococcus aureus and Streptococcus viridis were pathogenic bacteria, and the aortic valve was involved. Vancomycin treatment is effective.

A 34-year-old female was seen for lower abdominal pain for 1 month and aggravated for 1 week. Ultrasound showed that a mixed echo mass was detected in the lower abdominal cavity, and a large number of gas echoes were seen in it. The boundary of the mass was not clear, and many places communicated with the intestinal cavity. Ultrasound diagnosis: mixed echo mass in the abdominal cavity: ileouterine fistula; Inflammatory masses. Enhanced CT showed CT diagnosis: ileouterine fistula, ileal perforation with surrounding inflammatory mass formation. Colonoscopy revealed a terminal ileal ulcer and multiple polyps in the colon.