A clinical analysis of uterine artery embolisation in the treatment of placenta praevia or placenta praevia state

The aim of this study was to investigate the efficiency of uterine artery embolisation (UAE) for postpartum haemorrhage (PPH) related to placenta praevia. A total of 45 women with placenta praevia or placenta praevia state underwent UAE before inducing labour. The locations of uterine artery and placenta were determined through selective and super-selective catheterisation into the internal iliac artery and uterine artery digital subtraction angiography (DSA). The target arteries were then super-selectively catheterised and embolised using small pieces of gelatin sponge. The above processes were repeated until the darkly stained areas of placenta were no longer developing. The success rate of UAE was 100%. There was no longer haemorrhage after embolisation for all the cases of labour induction and the average volume of blood loss was 56 ml. UAE is an effective, reliable and minimally traumatic treatment method for preventing postpartum haemorrhage after induction of labour in patients with placenta praevia state.

Application of (68)Ga-PRGD2 PET/CT for αvβ3-integrin imaging of myocardial infarction and stroke

Purpose: Ischemic vascular diseases, including myocardial infarction (MI) and stroke, have been found to be associated with elevated expression of α_vβ₃-integrin, which provides a promising target for semi-quantitative monitoring of the disease. For the first time, we employed ⁶⁸Ga-S-2-(isothiocyanatobenzyl)-1,4,7-triazacyclononane-1,4,7-triacetic acid-PEG3-E[c(RGDyK)]₂ (⁶⁸Ga-PRGD2) to evaluate the α_vβ₃-integrin-related repair in post-MI and post-stroke patients via positron emission tomography/computed tomography (PET/CT).

Methods: With Institutional Review Board approval, 23 MI patients (3 days-2 years post-MI) and 16 stroke patients (3 days-13 years post-stroke) were recruited. After giving informed consent, each patient underwent a cardiac or brain PET/CT scan 30 min after the intravenous injection of ⁶⁸Ga-PRGD2 in a dose of approximately 1.85 MBq (0.05 mCi) per kilogram body weight. Two stroke patients underwent repeat scans three months after the event.

Results: Patchy ⁶⁸Ga-PRGD2 uptake occurred in or around the ischemic regions in 20/23 MI patients and punctate multifocal uptake occurred in 8/16 stroke patients. The peak standardized uptake values (pSUVs) in MI were 1.94 ± 0.48 (mean ± SD; range, 0.62-2.69), significantly higher than those in stroke (mean ± SD, 0.46 ± 0.29; range, 0.15-0.93; P < 0.001). Higher ⁶⁸Ga-PRGD2 uptake was observed in the patients 1-3 weeks after the initial onset of the MI/stroke event. The uptake levels were significantly correlated with the diameter of the diseases (r = 0.748, P = 0.001 for MI and r = 0.835, P = 0.003 for stroke). Smaller or older lesions displayed no uptake.

Conclusions: ⁶⁸Ga-PRGD2 uptake was observed around the ischemic region in both MI and stroke patients, which was correlated with the disease phase and severity. The different image patterns and uptake levels in MI and stroke patients warrant further investigations.

Survey and analysis of visual acuity of Kazakhs in different lighting environments

The effect of different lighting environments on the vision and refractive error were investigated in 427 Kazakhs (828 eyes) aged from 40 to 60 years old, of which 279 were pastoral (546 eyes) and 148 were urban (282 eyes). Pastoral Kazakhs use natural illumination, whereas city Kazakhs mainly use artificial illumination. Of all cases, 19.1% (54 cases) had a vision of 0.4 to 0.5, 20.9% (59 cases) had 0.6 to 0.8, and 17.7% (50 cases) had above 1.0. However, the visual acuity distribution of the pastoral Kazakhs had a more obvious characteristic, which was mainly concentrated above 0.6. The vision of 25.1% (137) of cases was 0.6 to 0.8, whereas 58.4% (319) of cases had vision above 1.0. There were more cases with vision above 1.0 in the pastoral Kazakhs compared to the city Kazakhs (P < 0.05). The diopter of the city Kazakhs was between 0 D and -4.0 D, whereas that of the pastoral Kazakhs was between +2.0 D and -2.0 D. Diopters between +2.0 D and 0 D or less than 3.0 D differed significantly between the two groups. Daylight lamps were the main illumination photosources of the city Kazakhs. Artificial light illuminated 70.9% (105 cases) of the city Kazakhs for more than 6 h. By contrast, natural light illuminated 75.3% (210 cases) of the pastoral Kazakhs for an outdoor activity time of more than 9 h. These results suggest that poor lighting environment is a very important factor contributing to refractive error.

Levels and distribution of heavy metals in atmospheric particular matters over the northern South China Sea

Oceans play a significant role in the cycling of trace metals and persistent organic pollutants. In this study, aerosol samples covering the whole northern South China Sea (SCS) were collected in 2005 and 2007, respectively, for analysis of trace metals and major elements. The levels of trace metals detected ranged from 0.514 to 119 ng/m(3) in 2005 and from 0.130 to 24.2 ng/m(3) in 2007, respectively. Cu, Zn, and Pb were the three predominant metals with high enrichment factors (>10), indicating the strong anthropogenic inputs. The trace metals over SCS were comparable to the values in suburban and background sites of South China, but generally higher than those over other seas and oceans. Considering the fact that they were influenced by their proximity to source regions and air mass origins, the elevated metals in 2005 were probably attributed to the strong wind and long-range atmospheric transport driven by Asian monsoon.

Polychlorinated biphenyls (PCBs) and hexachlorobenzene (HCB) in the equatorial Indian Ocean: temporal trend, continental outflow and air-water exchange

Nineteen pairs of air and seawater samples collected from the equatorial Indian Ocean onboard the Shiyan I from 4/2011 to 5/2011 were analyzed for PCBs and HCB. Gaseous concentrations of ∑(ICES)PCBs (ICES: International Council for the Exploration of the Seas) and HCB were lower than previous data over the study area. Air samples collected near the coast had higher levels of PCBs relative to those collected in the open ocean, which may be influenced by proximity to source regions and air mass origins. Dissolved concentrations of ∑(ICES)PCBs and HCB were 1.4-14 pg L⁻¹ and 0.94-13 pg L⁻¹, with the highest concentrations in the sample collected from Strait of Malacca. Fugacity fractions suggest volatilization of PCBs and HCB from the seawater to air during the cruise, with fluxes of 0.45-34 ng m⁻² d⁻¹ and 0.36-18 ng m⁻² d⁻¹, respectively.

Design and performance of a scanning ptychography microscope

We have designed and constructed a dedicated instrument to perform ptychography measurements and characterization of multilayer Laue lenses nanofocusing optics. The design of the scanning microscope provides stability of components and minimal thermal drifts, requirements for nanometer scale spatial resolution measurements. We performed thorough laboratory characterization of the instrument in terms of resolution and thermal drifts with subsequent measurements at a synchrotron. We have successfully acquired and reconstructed ptychography data yielding 11 nm line focus.

Strategy and long-term outcomes of endovascular treatment for Budd-Chiari syndrome complicated by inferior vena caval thrombosis

OBJECTIVES

The aim of this study was to evaluate the strategy and long-term outcomes of endovascular treatment of Budd-Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis.

METHODS

The treatment strategy and outcomes of BCS complicated by IVC thrombosis were retrospectively evaluated in a single-center study. The treatment was aimed at the IVC thrombus, not hepatic vein occlusion. All 133 patients with BCS complicated by IVC thrombosis from February 2003 to March 2013 underwent endovascular treatment. For the fresh thrombus group (n=75) recanalization was performed after transcatheter thrombolysis with urokinase. For the mixed thrombus group (n=19) a small balloon pre-dilation of the IVC was performed first, followed by transcatheter thrombolysis using urokinase and a large balloon dilation of the IVC. For the old thrombus group (n=39) a large balloon dilation or/and stent placement was performed directly. Pre- and post-treatment follow-ups were recorded.

RESULTS

The endovascular treatment was successful in 131 out of 133 patients (98.5%). Thirty seven patients had synchronous hepatic vein occlusion. The incidence of serious complications was 4.5% (6/133). Symptomatic pulmonary embolism occurred in three cases, cerebral hemorrhage in two, and cardiac tamponade in one. The cumulative 1-, 5-, and 10-year primary patency rate was 96.3%, 84.0%, and 64.6%, respectively. The cumulative 1-, 5-, and 10-year secondary patency rate was 99.0%, 96.1% and 91.3%, respectively. Segmental occlusion of the IVC and duration of anticoagulant therapy less than 6 months were independent risk factors for reocclusion.

CONCLUSIONS

For patients with BCS complicated by IVC thrombosis, an individualized treatment strategy based on the property of the thrombus can result in excellent long-term patency.

High-resolution MRI findings in patients with capsular warning syndrome

Background

Capsular warning syndrome (CWS) is rare (1.5% of TIA presentations) but has a poor prognosis (7-day stroke risk of 60%). Up to date, the exact pathogenic mechanism of CWS has not been fully understood. We report the clinical presentations and high-resolution MRI (HR MRI) findings of two cases with capsular warning symptoms.

Case presentation

Case 1 was a 63-year-old man with a history of hypertension with recurrent episodes of left hemiparesis and dysarthria lasting 10 ~ 30 minutes. Case 2 was a 54-year-old woman with repetitive episodes of transient left hemiparesis and dysarthria lasting about 10 minutes. Capsular infarctions on DWI were demonstrated in the territory of a lenticulostriate artery in both 2 patients. HR MRI disclosed atherosclerotic plaques on the ventral wall of the MCA where enticulostriate arteries were arisen from, although traditional digital subtraction angiography showed normal. Aggressive medical therapy with dual antithrombotic agents and statin was effective in these two cases.

Conclusion

Our HR MRI data offer an insight into the pathophysiology of CWS which might be caused by atherosclerotic plaque in non-stenotic MCA wall. HR MRI might be a useful modality for characterizing atherosclerotic plaques in the MCA and detecting the pathophysiology of the CWS.

Spontaneous neuronal activity predicts intersubject variations in executive control of attention

Executive control of attention regulates our thoughts, emotion and behavior. Individual differences in executive control are associated with task-related differences in brain activity. But it is unknown whether attentional differences depend on endogenous (resting state) brain activity and to what extent regional fluctuations and functional connectivity contribute to individual variations in executive control processing. Here, we explored the potential contribution of intrinsic brain activity to executive control by using resting-state functional magnetic resonance imaging (fMRI). Using the amplitude of low-frequency fluctuations (ALFF) as an index of spontaneous brain activity, we found that ALFF in the right precuneus (PCUN) and the medial part of left superior frontal gyrus (msFC) was significantly correlated with the efficiency of executive control processing. Crucially, the strengths of functional connectivity between the right PCUN/left msFC and distributed brain regions, including the left fusiform gyrus, right inferior frontal gyrus, left superior frontal gyrus and right precentral gyrus, were correlated with individual differences in executive performance. Together, the ALFF and functional connectivity accounted for 67% of the variability in behavioral performance. Moreover, the strength of functional connectivity between specific regions could predict more individual variability in executive control performance than regionally specific fluctuations. In conclusion, our findings suggest that spontaneous brain activity may reflect or underpin executive control of attention. It will provide new insights into the origins of inter-individual variability in human executive control processing.

Implementation of a structured guideline-based program for the secondary prevention of ischemic stroke in China

BACKGROUND AND PURPOSE

High rates of ischemic stroke and poor adherence to secondary prevention measures are observed in the Chinese population.

METHODS

We used a national, multicenter, cluster-randomized controlled trial in which 47 hospitals were randomized to either a structured care program group (n=23) or a usual care group (n=24). The structured care program consisted of a specialist-administered, guideline-recommended pharmaceutical treatment and a lifestyle modification algorithm associated with written and Internet-accessed educational material for patients for the secondary prevention of ischemic stroke. The primary efficacy outcome was the proportion of patients who adhered to the recommended measures at 12-month postdischarge. This trial is registered with ClinicalTrial.gov (NCT00664846).

RESULTS

At 12 months, 1287 (72.1%) patients in the Standard Medical Management in Secondary Prevention of Ischemic Stroke in China (SMART) group and 1430 (72%) patients in the usual care group had completed the 12-month follow-up (P=0.342). Compared with the usual care group, those in the SMART group showed higher adherence to statins (56% versus 33%; P=0.006) but no difference in adherence to antiplatelet (81% versus 75%; P=0.088), antihypertensive (67% versus 69%; P=0.661), or diabetes mellitus drugs (73% versus 67%; P=0.297). No significant difference in the composite end point (new-onset ischemic stroke, hemorrhagic stroke, acute coronary syndrome, and all-cause death) was observed (3.56% versus 3.59%; P=0.921).

CONCLUSIONS

The implementation of a program to improve adherence to secondary ischemic stroke prevention efforts in China is feasible, but these programs had only a limited impact on adherence and no impact on 1-year outcomes. Further development of a structured program to reduce vascular events after stroke is needed. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00664846.

Analysis of drug resistance-associated proteins expressions of patients with the recurrent of acute leukemia via protein microarray technology

INTRODUCTION

To detect the expressions of drug-resistance related proteins in bone marrow mononuclear cells of acute leukemia (AL) patients using protein microarray and to analyze the clinical value of protein microarray in predicting prognosis of AL patients.

PATIENTS AND METHODS

A total of 48 AL patients received chemotherapy were divided into four groups: recurrent acute myeloid leukemia group (R-AML; n=15); AML continue remission group (AML-CR; n = 13); recurrent acute lymphocytic leukemia group (R-ALL; n=13); and ALL-CR group (n=7). Fifteen age-matched patients with non-hematologic disease were used as controls.

RESULTS

Expression levels of P-gp, LRP/MVP, BCL-2, GST-π, PCNA, CXCR4 were increased significantly in both AML-R and ALL-R groups (p < 0.05). Besides, LFA-1 and TRAIL-R were also up-expressed significantly in ALL-R group (p < 0.05). In addition, the levels of P-gp, GST-π expressed in AML-R group were higher than those in AML-CR group (p < 0.05) and P-gp, LRP/MVP, GST-π, LFA-1 and CXCR4 in ALL-R were expressed higher than those in ALL-CR group (p < 0.05).

CONCLUSIONS

The recurrent of AL were related closely to the over expression of drug resistance-related proteins. Protein microarray can be used in the prediction of AL recurrence and would be beneficial in guiding individual therapy and patient prognosis.

Creatinine clearance rate and serum creatinine concentration are related to delayed methotrexate elimination in children with lymphoblastic malignancies

Methotrexate (MTX) is an effective treatment for childhood acute lymphoblastic leukemia (ALL) or Non-Hodgkin lymphoma (NHL); however, toxicity can arise with high doses MTX (HDMTX), especially in patients with delayed MTX elimination. Routine monitoring of plasma MTX concentrations is clinically important, but unfortunately is not always feasible. The aim of this study was to examine the relationship between MTX elimination and renal function to identify parameters that may be useful for predicting delayed MTX elimination in Chinese children with ALL and NHL. A total of 105 children with ALL and NHL were included in the study. Each patient received HDMTX (3 or 5 g/m2) over 24 hours. Plasma MTX concentrations were measured at 24, 48, and 96 hours. Delayed elimination was indicated by plasma MTX concentrations ≥1.0 at 48 hours or ≥0.1 μmol/L at 96 hours. Creatinine clearance rate (CCr) and serum Cr concentrations were measured at 0, 24, and 48 hours. There were 39 patients (37.1%) with delayed MTX elimination. For patients with delayed MTX elimination, the 24 hour plasma MTX concentration was negatively correlated with the 24 hour CCr (P=0.019). The 48 hour plasma MTX concentration was positively correlated with 24 and 48 hour serum Cr concentrations (P=0.001 and P<0.001, respectively), and negatively correlated with the 24 and 48 CCr (both P<0.001). Both MTX concentrations and elimination time decreased with increasing CCr (P<0.05 and P<0.001, respectively). Receiver operating characteristic curves revealed that the best predictors of delayed MTX elimination were 24 hour CCr 36 mmol/L (sensitivity: 64.7%; specificity: 77.4%) (both P < 0.001). CCr and serum Cr concentration may be useful for monitoring plasma MTX concentrations in children receiving HDMTX for ALL and NHL and for predicting delayed MTX elimination.