BackgroundBloodstream infections (BSI) in intensive care unit (ICU) patients are associated with high morbidity and mortality, necessitating rapid and accurate pathogen identification to guide early antimicrobial therapy. However, traditional blood culture (BC) is limited by the long turnaround time and low sensitivity. Metagenomic next-generation sequencing (mNGS) has been applied in infectious disease diagnostics, but its clinical utility for perioperative ICU patients with BSI requires further evaluation.MethodsThis post-hoc analysis included 219 perioperative ICU patients (from a prospective, multi-center cohort, July 2020–June 2023) who underwent concurrent mNGS and BC testing. The study compared pathogen detection differences between the two methods, and evaluated the diagnostic value of mNGS for clinical BSI based on mNGS-assisted clinical diagnostic criteria. Additionally, the impact of mNGS findings on clinical antimicrobial management was assessed.ResultsmNGS demonstrated a higher overall pathogen detection rate than BC in the 219 enrolled patients (25.1% vs. 9.6%, p < 0.001), with significant advantages in detecting Gram-negative bacteria (13.2% vs. 5.9%, p = 0.009), anaerobes (3.6% vs. 0.5%, p = 0.018), and fungi (6.4% vs. 0.9%, p = 0.002). Mixed-pathogen infections were identified in 20% of mNGS-positive clinical BSI cases, whereas BC-positive cases exclusively had single-pathogen infections. Ultimately, 64 patients (29.2%) were diagnosed with clinical BSIs. The sensitivity and specificity of the mNGS were 85.9% (95% CI: 74.5%–93.0%), and 80.6% (95% CI: 73.4%–86.4%), respectively, and the area under the receiver operating characteristic curve was 0.833 (95% CI: 0.772–0.894). The positive predictive value and negative predictive value were 64.7% (95% CI: 53.5%–74.6%) and 93.3% (95% CI: 87.3%–96.7%), respectively. Additionally, mNGS led to a positive impact in 56 patients (25.6%), manifested by the identification of new pathogens and guidance for targeted therapy, a negative impact in 11 patients (5.0%), and no clinical impact in 152 patients (69.4%).ConclusionsFor perioperative ICU patients, mNGS demonstrated superior pathogen detection rates, broader microbial spectrum coverage, and enhanced polymicrobial infection detection capability versus BC. mNGS exhibited high diagnostic value for clinical BSI, with the potential to facilitate targeted antimicrobial therapy adjustments.

Objective Contrast-induced acute kidney injury (CI-AKI) is a serious complication following endovascular procedures, yet its risk profile in patients with peripheral vascular disease (PVD) remains poorly defined. This study aimed to identify independent risk factors for CI-AKI in PVD patients undergoing diagnostic or therapeutic endovascular interventions, with the goal of discovering strategies to reduce the incidence of CI-AKI. Methods A retrospective cohort study was conducted on 782 consecutive PVD patients who underwent endovascular procedures in the Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, between January 2018 and December 2024. Baseline demographic data, comorbidities, and laboratory parameters were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of CI-AKI. Results Postprocedural CI-AKI occurred in 54 patients (6.9%). Multivariate logistic regression analysis revealed that: Remote ischemic preconditioning (RIPC) (OR = 0.090, 95%CI: 0.011–0.715, P = 0.023) and hemoglobin level (OR = 0.965, 95%CI: 0.949–0.981, P < 0.001) were protective factorsagainst CI-AKI; Carotid artery stenting (OR = 3.338, 95%CI: 1.712–6.505, P < 0.001), history of diuretic use(OR = 2.726, 95%CI: 1.170–6.349, P = 0.020), and uric acid level (OR = 1.005, 95%CI: 1.003–1.008, P < 0.001) were independent risk factors for CI-AKI. Conclusion Remote ischemic preconditioning exerts a significant and potent protective effect against CI-AKI in PVD patients undergoing endovascular interventions. Carotid artery intervention, diuretic use, and hyperuricemia are major risk factors. These findings provide a simple, low-cost, and non-invasive preventive strategy for perioperative renal protection in high-risk populations, warranting further validation in large-scale prospective studies. Level of Evidence: Level III, Retrospective cohort study.

Abstract Background Bloodstream infection (BSI) is associated with a high mortality, ranging from 17 to 32%. Once pathogens enter the bloodstream, they can activate platelets and trigger systemic inflammation. Antiplatelet agents suppress platelet activation and modulate inflammatory responses; however, it remains unclear whether their use reduces mortality in patients with BSI. This study aimed to evaluate the impact of antiplatelet therapy on clinical outcomes in patients with BSI. Methods We retrospectively analyzed patients diagnosed with BSI at Xuanwu Hospital, Capital Medical University, between 2013 and 2023. Patients were categorized into antiplatelet and non-antiplatelet groups. Propensity score matching was performed to minimize potential confounders, including age, sex, body mass index, year of onset, Charlson Comorbidity Index, and anticoagulant therapy. For the primary outcome (30-day all-cause mortality), group differences were analyzed using the logistic regression models, with results reported as odds ratios and 95% confidence intervals. Secondary endpoints, including respiratory failure, septic shock, acute kidney injury, and bleeding events, were similarly compared using the logistic regression. Subgroup analyses were performed according to causative pathogens and types of antiplatelet agents, with covariates showing standardized mean differences >0.1 included in the models. Main results After Propensity score matching, a total of 248 patients were included in the analysis, with 124 patients in each group). The 30-day all-cause mortality following BSI diagnosis was significantly lower in the antiplatelet group (OR 0.35; 95% CI 0.17–0.71, P = 0.004). Septic shock, respiratory failure, acute kidney injury, and bleeding events showed no significant differences between groups (OR 1.08; 95% CI 0.50–2.34; P = 0.843, OR 0.72; 95% CI 0.33–1.60; P = 0.424, OR 1.20; 95% CI 0.31–2.33; P = 0.608, OR 0.71; 95% CI 0.55–2.37; P = 0.712). Subgroup analyses revealed that antiplatelet therapy significantly reduced mortality in patients with Gram-negative BSI (OR 0.26; 95% CI 0.08–0.87; P = 0.029). In addition, clopidogrel monotherapy was associated with lower mortality (OR 0.17; 95% CI 0.03–0.90; P = 0.017). Conclusions In patients with BSI, antiplatelet therapy significantly reduced 30-day all-cause mortality without an increasing risk of bleeding.

Lower extremity arterial disease is extremely complex. Endovascular treatment for lower extremity arteries is minimally invasive, and patients may recover soon after operation. Intervention for lower extremity arterial disease requires a high dose of iodinated contrast agents, and the incidence of iodinated contrast agent-related acute kidney injury (AKI) after intervention is not low, and is independently related to in-hospital mortality. To prevent and treat iodinated contrast agent-related AKI, and to benefit patients more, this guideline is established based on existing guidelines, expert opinions, new evidence, and clinical practice. The consensus includes definition, pathological characteristics, risk factors, risk assessment, hydration protocol, and medications of iodinated contrast agent-related AKI.

ObjectiveTo investigate and compare the changes in cognitive function after carotid artery revascularization surgery on different sides.MethodsFrom April 2019 to April 2021, patients with ≥70% carotid artery stenosis who were treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) were recruited for this study. The Montreal Cognitive Assessment (MoCA) instrument was used to evaluate cognitive function preoperatively and at 3, 6, and 12 months postoperatively. Patients were divided into two groups based on the side of the surgery, repeated measures ANOVA was used for comparisons.ResultsA total of 89 patients who met the criteria were enrolled and completed 1-year follow-up. At 3, 6, and 12 months after carotid revascularization, the total MoCA score and delayed recall score were significantly improved compared with the baseline scores (p < 0.05). In patients who underwent left-sided revascularization, verbal fluency showed improvement at 12 months compared to baseline levels (p < 0.05). In patients who underwent right-sided revascularization, attention showed improvement at 6 months compared to baseline, and the improvement in delayed recall at 6 and 12 months was still evident compared to the 3-month assessment (p < 0.05).ConclusionCarotid revascularization can improve cognitive function in patients, with differences in cognitive function changes observed between left and right carotid revascularization procedures.

Objective To investigate and compare changes in cognitive function following revascularization between patients with symptomatic and asymptomatic carotid stenosis. Methods From April 2019 to April 2022, patients carotid artery stenosis who were treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) were recruited for this study. The Montreal Cognitive Assessment (MoCA) instrument was used to evaluate cognitive function preoperatively and at 3, 6, and 12 months postoperatively. Patients were divided into two groups based on the neurological symptoms, repeated measures ANOVA was used for comparisons. Results A total of 89 patients who met the criteria were enrolled and completed 1-year follow-up, divided into symptomatic group (32 patients) and asymptomatic group (57 patients). Baseline data showed no significant differences in clinical characteristics between the two groups. At 3, 6, and 12 months after carotid revascularization, the total MoCA and delayed recall scores for both groups showed significant increases compared to baseline levels. In patients with asymptomatic, attention also showed improvement at 3, 6 months compared to baseline (p < 0.05). Conclusion Carotid revascularization has a positive impact on cognitive function improvement, particularly in delayed recall and attention.

Objective: To determine the link between heart rate variability (HRV) and short-term adverse outcomes (re-hospitalisation or death due to cardiac arrhythmia, recurrent myocardial infarction, heart failure, all-cause death) in acute myocardial infarction Study Design: A descriptive study. Methodology: Clinical data of 245 patients diagnosed with AMI were retrospectively analysed. After discharge from the hospital, patients were followed for a year and categorised into two groups based on the occurrence of adverse events: the adverse event group (n=82) and the no adverse event group (n=163). Differences in clinical characteristics were compared, independent factors influencing adverse events were analysed, and diagnostic efficacy was assessed. Results: Univariate analysis showed age, hyperlipidaemia, specific HRV parameters (SDNN, SDANN, RMSSD, PNN50, LF/HF), and myocardial injury markers (CK-MB, cTnI, NT-proBNP) as associated with these events (all p < 0.05). Multivariable analysis revealed decreased SDNN, decreased SDANN, increased LF/HF, and elevated levels of CK-MB, cTnI, and NT-proBNP as independent influences. Both HRV parameters and myocardial injury markers were reliable predictors on ROC curve analysis. The highest diagnostic efficacy was achieved by combining these predictors. Conclusion: AMI patients frequently experience short-term adverse events. Both HRV parameters and myocardial injury markers, which demonstrate significant predictive efficacy, independently influence these outcomes.

Purpose: The impact of carotid revascularization on cognitive function for patients with severe carotid artery stenosis remains uncertain. This study is aimed to investigate the 1-year neurocognitive outcomes of patients who accept carotid revascularization and identify the risk factors associated with postoperative cognitive decline. Methods: From April 2019 to April 2021, patients with ≥70% carotid artery stenosis who were treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) were recruited for this study. The Montreal Cognitive Assessment (MoCA) instrument was used to evaluate cognitive function preoperatively and at 3, 6, and 12 months postoperatively. Logistic regression analysis was built to identify potential risk factors for postoperative long-term cognitive decline. Results: A total of 89 patients who met the criteria were enrolled and completed 1-year follow-up. At 3, 6, and 12 months after carotid revascularization, the total MoCA score, attention, language fluency, and delayed recall score were significantly improved compared with the baseline scores (p<0.05). At 12 months, there was also a significant improvement in cube copying compared with baseline (p=0.034). Logistic regression analysis showed that the advancing age, left side, and symptomatic carotid artery stenosis were independent risk factors for cognitive deterioration at 12 months after surgery. Conclusions: Overall, carotid revascularization has a beneficial effect on cognition function in patients with severe carotid artery stenosis, while advancing age, left side, and symptomatic carotid artery stenosis were significantly related to a decreased cognitive score after carotid revascularization. Clinical Impact This study focused on the changes in cognitive function within 1 year after carotid revascularization in patients with severe carotid stenosis. Of course, carotid revascularization can improve the cognition function in these patients. On the other hand, we found the advancing age, left side and symptomatic carotid artery stenosis were significantly associated with decreased cognitive scores at 1 year after carotid revascularization, which suggests that clinicians may need to be aware of patients with these characteristics.

In the present study, the mechanism of Panax notoginseng saponins (PNS), the extract of Panax notoginseng, against deep vein thrombosis (DVT) was explored by networks pharmacology and its effect was demonstrated through clinical data. PNS includes 5 main active components, which have 101 targets. A total of 1,342 DVT-related targets were obtained, 55 of which were the common targets of PNS and DVT. AKT1, TNF, IL1B, EGFR, VEGFA and MAPK3 were selected as hub genes from the protein-protein interaction network. The potential anti-DVT mechanism of PNS may involve the AGE-RAGE signaling pathway and the PI3K-Akt signaling pathway. Molecular docking presented a total of 10 binding interactions, with all molecules showing good binding ability with PNS-DVT common hub target genes (all binding energy <-6 kcal/mol). Analysis of clinical data showed that the combined use of PNS significantly reduced the incidence of postoperative DVT in patients undergoing orthopedic surgery compared with the use of low-molecular-weight heparin alone, which is the most commonly used clinical anticoagulant.

Background:The accurate placement of stents for treatment of coronary aorto-ostial lesions (AOLs) is technically challenging. The purpose of this study was to evaluate the efficacy and safety of a stent positioning system with a dedicated nitinol device and compare them with those of the conventional approach for stenting of coronary AOLs.Methods:In this prospective, multi-center, open-label, randomized study, conducted from November 2015 to April 2019, patients with coronary AOLs that underwent percutaneous coronary intervention (PCI) were randomly allocated (allocation ratio 1:1) using block randomization method to either a stent positioning system group or a conventional technique group. The primary endpoint was the range of stent slippage when positioning. The following secondary endpoints were applied: (I) the extent of swing of the guiding catheters during stent positioning; (II) the rate of accurate stent placement; (III) the procedure time; and (IV) the incidence of major adverse cardiovascular events (MACEs) including cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis.Results:During the study period, 139 patients with aorto-ostial coronary artery stenosis were included at 5 centers. A total of 69 patients were allocated to the stent positioning system group and 70 patients to the conventional technique group. Angiographic and clinical success were achieved in 100% of the patients included in both groups. The range of stent slippage was significantly shorter in the stent positioning system group than it was in the conventional technique group [0.64 (0.22; 1.35) vs. 1.11 (0.48; 1.72) mm, P=0.01]. The rate of accurate placement of stents was higher in the stent positioning system group than it was in the conventional technique group (74.6% vs. 57.1%, P=0.03). The extent of guiding catheter swing during the stent positioning [0.24 (0.19; 0.53) vs. 0.23 (0.19; 0.53) mm; P=0.95] and the MACEs rates (1.4% vs. 2.9%, P>0.99) were similar between the 2 groups. The procedural time of the stent positioning system was longer than that of the conventional approach [1.00 (0.50; 1.50) vs. 0.80 (0.50; 1.50) min, P=0.09].Conclusions:The dedicated stent positioning system was is safer and provides more accurate placement of stents for coronary AOLs than the conventional approach, and the associated prolongation of procedure time is insignificant.Trial Registration:Chinese Clinical Trial Registry (ChiCTR), Unique identifier: ChiCTR2100053869. URL: https://www.chictr.org.cn/showproj.html?proj=133280.

Introduction Whether and when to monitor the amount of anti-factor Xa (aFXa) activity in critically ill patients with complex diseases to prevent venous thromboembolism (VTE) remain unclear. This study is a randomised controlled trial to investigate the effect of aFXa level monitoring on reducing VTE and to establish a new method for accurately preventing VTE in critically ill patients with low-molecular-weight heparin (LMWH).Methods and analysis A randomised controlled trial is planned in two centres with a planned sample size of 858 participants. Participants will be randomly assigned to three groups receiving LMWH prophylaxis at a 1:1:1 ratio: in group A, peak aFXa levels will serve as the guide for the LMWH dose; in group B, the trough aFXa levels will serve as the guide for the LMWH dose; and in group C, participants serving as the control group will receive a fixed dose of LMWH. The peak and trough aFXa levels will be monitored after LMWH (enoxaparin, 40 mg, once daily) reaches a steady state for at least 3 days. The monitoring range for group A’s aFXa peak value will be 0.3–0.5 IU/mL, between 0.1 and 0.2 IU/mL is the target range for group B’s aFXa trough value. In order to reach the peak or trough aFXa levels, groups A and B will be modified in accordance with the monitoring peak and trough aFXa level. The incidence of VTE will serve as the study’s primary outcome indicator. An analysis using the intention-to-treat and per-protocol criterion will serve as the main outcome measurement.Ethics and dissemination The Xuanwu Hospital Ethics Committee of Capital Medical University and Peking University First Hospital Ethics Committee have approved this investigation. It will be released in all available worldwide, open-access, peer-reviewed publications.Trial registration number NCT05382481

目的:探讨青年肥胖(OB)合并代谢综合征(MS)患者颈动脉弹性变化及其危险因素.方法:选取医院收治的108例20～40岁的OB患者,依据是否合并MS将其分为OB合并MS(OB-MS)组(57例)和单纯OB组(51例),同期选取来院体检的47名体重正常受检者纳入健康对照组.收集入组者的性别、年龄、血糖、血脂、血压、右侧颈动脉内中膜厚度(CIMT)及右侧颈动脉局部脉搏波传导速度(PWV),比较3组间上述观察指标的差异,应用多元线性回归模型分析OB-MS组右侧颈动脉局部PWV升高的危险因素.结果:OB-MS组的高血糖、高血压及血脂异常的检出率明显高于健康对照组,差异有统计学意义(x2=85.18,x2=29.83,x2=75.51;P<0.001);单纯OB组高血糖、高血压和血脂异常与OB-MS组比较,差异有统计学意义(x2=39.77,x2=26.14,x2=38.19;P<0.001);单纯OB组高血糖、血脂异常的检出率高于健康对照组,差异均有统计学意义(x2=17.21,x2=13.33;P<0.001);OB-MS组的右侧颈动脉CIMT、右侧颈动脉局部PWV明显高于健康对照组(Z=41.94,Z=38.11;P<0.001);OB-MS组的右侧颈动脉局部PWV高于单纯OB组(Z=27.03,P<0.017);单纯OB组的右侧颈动脉CIMT高于健康对照组(Z=21.48,P<0.017);多元线性回归分析显示:右侧颈动脉CIMT增厚、体质量指数(BMI)增加是OB-MS组右侧颈动脉局部PWV升高影响因素.结论:无动脉粥样硬化斑块的青年OB-MS患者颈动脉弹性减低,CIMT和BMI增加是其危险因素.

目的:探讨常规超声(US)、超声造影(CEUS)及动态增强核磁共振成像(DCE-MRI)评估乳腺浸润性导管癌病灶大小的准确性.方法:选取医院收治的39例(39个病灶)乳腺浸润性导管癌患者,术前均行常规US、CEUS及DCE-MRI 3种影像学检查,以术后病理结果为"金标准",比较常规3种影像学检查与术后病理结果测得肿瘤最大径的差异,比较3种影像学检查方式测量病灶大小的准确率、低估率及高估率.结果:常规US测量的乳腺浸润性导管癌病灶大小显著小于术后病理结果,差异有统计学意义(t=2.459,P<0.019);CEUS及DCE-MRI测量病灶大小与术后病理结果比较,差异无统计学意义.常规US低估率显著高于CEUS和DCE-MRI,其差异有统计学意义(x2=7.123,x2=3.566;P<0.05);CEUS及DCE-MRI测量病灶大小的高估率显著高于常规US,其差异有统计学意义(x2=2.885,x2=2.167;P<0.05);3种影像学检查方式准确率比较,差异无统计学意义.Pearson相关性分析显示,常规US、CEUS和DCE-MRI测量的乳腺浸润性导管癌肿瘤最大径与术后病理结果具有相关性(r=0.658,r=0.761,r=0.602;P<0.05).结论:常规US、CEUS及DCE-MRI评估乳腺浸润性导管癌病灶大小的准确率无差异,常规US易低估病灶大小,CEUS和DCE-MRI易高估病灶大小,CEUS较DCE-MRI更加安全便捷.

Purpose: To investigate the efficacy and safety of unfractionated heparin (UFH) anticoagulant administered upstream in the ambulance or emergency room during primary percutaneous coronary intervention (pPCI) for patients with acute ST-segment elevation myocardial infarction (STEMI).Methods: The study included STEMI patients who received either early UFH subcutaneously (SC) (n = 163) or intraoperative UFH (SC) during pPCI (n = 476) between January 2017 to August 2018. Baseline characteristics, infarct-related artery (IRA) status, and procedural characteristics were analyzed. The primary endpoint was thrombolysis in myocardial infarction (TIMI) flow grade 2 - 3 before intervention. The secondary endpoints were time from first medical contact to guidewire passage, postoperative TIMI 3 flow grade, acute stent thrombosis, and in-hospital bleeding events.Results: Baseline characteristics were similar between the groups, with no significant difference in IRA location. Both groups underwent coronary angiography, with most patients receiving pPCI. The primary endpoint occurred in 18.1 % of patients in intraoperative UFH group and 27.6 % in the early UFH group, with a significant difference between the groups (p < 0.05). There was no significant difference in postoperative TIMI 3 flow grade or acute stent thrombosis, but bleeding events (BARC 2-5) were similar between groups (1.1 % in intraoperative group and 1.8 % in early UFH group, p > 0.05)Conclusion: Early upstream administration of UFH anticoagulation in STEMI patients improves coronary artery potency before pPCI, and early use of fixed-dose UFH is safe and does not increase major bleeding complications.

Objective:To investigate the risk factors related to the contrast-induced nephropathy(CIN)occurring after carotid artery stenting(CAS)in patients with carotid artery stenosis.Methods:The clinical data of 137 patients with carotid artery stenosis, who were treated with CAS at Xuanwu Hospital, Capital Medical University during the period from January to Decmber 2021 were retrospectively analyzed. Record demographic characteristics (age, gender, height, weight), history of underlying diseases (hypertension, diabetes, kidney disease, etc.), history of medications, etc. Observe the clinical parameters such as creatinine, blood urea nitrogen, albumin, hemoglobin, hematocrit, degree of stenosis and estimated glomerular filtration rate (eGFR). Measurement data conforming to the normal distribution were expressed as the mean±standard deviation( ± s), and the t-test was used for comparison between groups; the measurement data that does not conform to the normal distribution were expressed as the median (interquartile range) [ M( Q1, Q3)], and the Rank-sum test was used for comparison between groups; the Chi-square test or Fisher exact test was used for comparison of count data between groups. Relevant variables were subjected to univariate analysis, and statistically significant indicators were selected according to the results of univariate analysis to be included in the multivariate Logistic regression analysis. Results:After CAS, a total of 29 patients (21.2%) among the 137 patients developed CIN. Univariate analysis indicated that bilateral carotid artery stenosis, uncontrolled hypertension before surgery, history of angiotensin converting enzyme inhibitor drugs, diabetes mellitus, history of insulin drugs, eGFR<45 mL/(min·1.73 m 2), body weight were the influencing factors associated with the occurrence of CIN after CAS in patients with carotid artery stenting; multivariate regression analysis revealed that the presence of bilateral carotid artery stenosis( OR=4.724, 95% CI: 1.455-15.338, P=0.010), diabetes mellitus( OR=3.451, 95% CI: 1.345-8.858, P=0.010) and eGFR <45 mL/(min·1.73 m 2)( OR=4.582, 95% CI: 1.001-20.971, P=0.050) were the independent risk factors related to the CIN after CAS. Conclusion:Patients with the presence of bilateral carotid artery stenosis, diabetes mellitus or eGFR <45 mL/(min·1.73 m 2) are more likely to develop CIN after CAS.

目的:探讨超声造影在乳腺良、恶性结节中的应用价值.方法:选取医院行乳腺结节超声造影的340例(344枚结节)患者,所有患者均行超声引导下穿刺活检或手术切除,根据病理结果将其分为良性组(227例、229枚结节)和恶性组(113例、115枚结节),恶性组中原位癌23枚结节,浸润性癌92枚结节,分析恶性结节的独立危险因素及超声造影对恶性结节的诊断价值,以及组间超声造影参数的差异.结果:多因素Logistic回归分析结果显示,乳腺结节的增强范围、增强程度、增强均质性、形态、滋养动脉以及蟹足均为恶性结节的独立危险因素(OR=2.088,OR=2.127,OR=1.937,OR=3.387,OR=2.280,OR=2.757;P<0.05),且诊断价值较高.良性组与恶性组中原位癌比较,结节增强后形态、边界、蟹足及滋养动脉差异有统计学意义(x2=7.566,x2=5.794,x2=12.175,x2=19.442;P<0.05),原位癌与浸润性癌比较,仅增强范围差异具有统计学意义(x2=6.185,P<0.017).结论:超声造影不仅有助于乳腺良恶性结节的鉴别,亦可用于原位癌与良性结节的鉴别诊断.

目的 探讨老年无症状颈动脉狭窄患者颈动脉支架置入术(carotid artery stenting,CAS)后认知功能的变化.方法 选择2019年4—10月首都医科大学宣武医院血管外科住院治疗的老年无症状颈内动脉重度狭窄行CAS的患者25例,评估术前1周内和术后3、6、12个月的认知功能的蒙特利尔认知评估(Montreal cognitive assessment,MoCA),并对结果进行比较,同时统计患者12个月内同侧缺血性脑血管事件和再狭窄的发生率.结果 本组25例患者手术过程均顺利,4例患者术后1周复查脑MRI时发现亚临床微栓塞,1例患者术后即出现血流动力学不稳定.在12个月的随访中,无患者出现死亡、心肌梗死、颅内出血、短暂性脑缺血发作或同侧缺血性脑卒中.术后3、6、12个月复查血管超声未发现再狭窄发生.与术前基线检查时相比,术后3、6、12个月时的MoCA总分、注意力和延迟回忆得分均增加(P<0.05).画钟表评分在6个月时趋于增加,在12个月时与基线相比显著改善(P<0.05);立方体复制评分在12个月时与术前基线相比有所改善(P<0.05);与术后3个月认知评估相比,术后6个月和12个月MoCA总分进一步有改善(P<0.05).12个月时执行功能(复制立方体及画钟表)较3个月时均有改善(P<0.05).术后12个月与术后6个月相比,MoCA总分及画钟表改善(P<0.05).结论 颈动脉支架成形术可能改善老年无症状性颈动脉重度狭窄患者1年内认知功能.

目的 探讨颈动脉狭窄患者颈动脉支架植入术(CAS)后产生低血压的危险因素.方法 回顾性分析2018年1月至12月在首都医科大学宣武医院接受CAS治疗的137颈动脉狭窄患者临床资料.患者平均年龄66.3岁,手术侧颈动脉重度狭窄98例,中度狭窄39例.采用单因素和多因素logistic回归法分析评价持续性低血压的危险因素.结果 137例颈动脉狭窄患者CAS术后有51例(37.2％)发生低血压.单因素分析提示,与CAS术后低血压相关的因素,包括颈动脉狭窄部位在球部、术前存在未控制的高血压、钙通道阻滞剂(CCB)类药物史、尿素氮、术后24 h静脉液体入量.多因素logistic回归分析结果显示,有溃疡斑块、术前存在未控制高血压、术后24 h静脉液体入量,是CAS术后低血压的独立危险因素.结论 有溃疡斑块、术前高血压未控制、术后24h液体入量较多患者,更易发生CAS术后低血压.

Background: To investigate cognitive changes after carotid revascularization in elderly pa-tients with asymptomatic carotid artery stenosis. We also compared cognitive outcomes of ca-rotid endarterectomy CEA with stenting in asymptomatic patients. Methods: From April 2019 to December 2019, patients with >70% asymptomatic carotid steno-sis who were treated with CEA or CAS, were recruited for this study. The Montreal cognitive assessment (MoCA) instrument was used to evaluate cognitive function preoperatively and postoperatively at 3, 6, and 12 months. The incidence of ipsilateral ischemic cerebrovascular events and restenosis were analyzed within 12 months.Results: In 50 patients treated with CEA or carotid artery stenting CAS, baseline cognitive func-tion was not different between CEA and CAS groups (P > 0.05). There was no difference in the incidence of ipsilateral ischemic cerebrovascular events and restenosis within the first 12 months between the two groups. There was a significant improvement in the total MoCA score, scores of attention, and delayed recall at 3, 6 and 12 months after revascularization compared with scores at baseline (all P < 0.001). At 12 months, scores of cube copying and clock drawing were signif-icantly improved (P = 0.014, P = 0.020). The clock drawing score was improved at 12 months after CAS compared with CEA (P = 0.040).Conclusions: Carotid revascularization has a beneficial effect on cognition in asymptomatic patients within 12 months of the procedure. Compared with CEA, CAS show improved test scores of executive functioning by 1 year.