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Objective To investigate effects of combined clopidogrel-aspirin treatment for acute cerebral ischemie infarction on a correlation between cerebral microbleeds (CMBs)and hemorrhagic transformation(HT),so as to provide a new evidence for acute phase treatment of ischemic stroke with CMBs.Methods One hundred and forty-eighty patients with acute cerebral infarction meeting the inclusion criteria were consecutively admitted to our hospitals.All patients underwent susceptibility weighted imaging(SWI) to detect CMBs.Patients were classed into two groups:with and without CMBs and subdivided into brain lobe group,deep group and mixed group.The influence of CMBs or not and CMBs different positions on the post-infarction HT was compared.Logistic regression analysis was used to assess the relationship between HT and the related risk factors.Results The 142 patients finally were included in the study,with 64 patients without CMBs and 78 with CMBs.The detection rates of CMBs were 54.9％.Hypertensive prevalence rate(x2 =6.96,P =0.010)and the levels of uric acid (t =2.04,P =0.040) were higher in CMBs group than group without CMBs.The incidence rate of HT was 12.5 ％ (8 cases)in no CMBs group,and 21.8％(17 cases)in the CMBs group(x2 =2.09,P=0.150).6 in 15 patients(40.0％)patients experienced HT in lobar CMBs group;6 patients (12.5 ％)experienced HT in 48 patients with deep CMBs group;5 patients(33.3％)experienced HT in 15 patients with mixed CMBs group.There was statistically significant difference in HT incidence rate(x2 =6.52,P=0.038)among the 3 groups.Lobar CMBs are more vulnerable for HT.Logistic regression analysis showed that atrial fibrillation(OR=6.48,95 ％ CI:2.45-17.19,P =0.000) and hyperglycemia (OR =1.02,95 ％ CI:1.43 1.94,P =0.020) were risk factors for HT,instead of CMBs(OR=1.95,95％CI:0.78-4.87,P=0.150).Conclusions CMBs do not increase the risk of hemorrhage transformation in cerebral ischemic infarction patients at acute stage with combined antithrombotic treatment.While,the double antithrombotic treatment used in patients with the lobar CMBs should be careful.
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Objective To investigated the neuroprotective effect of PTEN inhibitor BPV on cerebral ischemia-reperfusion injury in rats and its mechanism. Methods Male Sprague-Dawley rats were used to induce a reperfusion model of middle cerebral artery occlusion for 1 h. During the reperfusion, the BPV solution (0. 2 mg/kg daily) or the equal volume of saline was injected intraperitonealy immediately. The neurological deficit scores were conducted at day 1, 3,5, and 7 after ischemia-reperfusion. At day 4, triphenyl tetrazolium chloride staining was used to assess cerebral infarction volume. Enzyme-linked immunosorbent assay was used to detect the levels of interleukin 10 (IL-10) and tumor necrosis factor α(TNF-α) in cortical ischemic border zones. Real-time quantitative polymerase chain reaction was used to detect the expression level of PTEN mRNA. Western blotting was used to detect the expression levels of PI3K, Akt, and p-GSK-3β. At day 7, Bielschowsky silver staining was used to detect the axonal distribution in the ischemic border zone of the striatum. Immunohistochemical staining was used to detect the expression of myelin basic protein (MBP). Results At day 4 after ischemia-reperfusion, the infarct volume (32. 27% ± 1. 71% vs. 45. 49% ± 2. 12% ; P < 0. 001), TNF-α concentration in the cortical ischemic border zones (134. 17 ± 10. 38 pg/ml vs. 264. 17 ± 24. 84 pg/ml; P < ), and PTEN mRNA level (1. 19 ± 0. 08 vs. 2. 50 ± 0. 06; P < 0. 001) in the rats of the BPV group were al significantly lower than those of the normal saline group. The IL-10 concentration (186. 83 ± 10. 83 pg/ml vs. 147. 83 ± 11. 62 pg/ml; P < 0. 001), and the expression levels of PI3K (0. 43 ± 0. 08 vs. 0. 26 ± 0. 06; P = 0. 004), Akt (0. 52 ± 0. 05 vs. 0. 40 ± 0. 04;P = 0. 001), and p-GSK-3β (0. 75 ± 0. 08 vs. 0. 38 ± 0. 06; P < 0. 001) were al significantly higher than those of the normal saline group. At day 7 after ischemia-reperfusion, the neurological deficit score (4. 83 ± 0. 41 vs. 6. 33 ± 0. 52; P < 0. 001) in the rats of the BPV group was significantly lower than that of the normal saline group. The axon densities in the ischemic border zones (35. 51% ± 2. 45% vs. 25. 31% ± 2. 79% ; P < 0. 001) and the expression level of MBP (32. 56% ± 3. 46% vs. 27. 81% ± 4. 18% ; P = 0. 037) were significantly higher than those of the normal saline group. Conclusions BPV has neuroprotective effect for cerebral ischemia-reperfusion injury in rats. Its mechanism may be associated with the up-regulation of PTEN downstream proteins PI3K, Akt and p-GSK-3β expression to regulate inflammatory mediators and reduce the inflammatory response.
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Objective To investigate the prevalence of HBV infection and the risk of hepatitis B virus (HBV) reactivation in patients with inflammatory arthritis receiving tumour hecrosis factor alpha (TNFα) inhibitors.Methods The liver function,serology of HBV and viral loads (HBV DNA) were tested before using TNFα inhibitors,at 3 months and 6 months.Patients with chronic hepatitis B (CHB) infection (HBV DNA ＞ 1 × 103copies/ml) were eliminated.Results A total of 162 patients were investigated including 156 patients who finished the study.Eleven (7.05％) patients were HBsAg-positive.Two patients with HBV DNA ＞ 1 × 103copies/ml were eliminated before starting anti-TNFα therapy.Among HBsAgpositive patients,HBV reactivation was documented in only one of the 11 patients.This patient with rheumatoid arthritis developed elevation of glutamic-pyruvic transaminase (ALT) and HBV DNA copies three months after infliximab therapy.Therefore lamivudine was given for three months,which translated into the fall of ALT and HBV DNA copies back to normal level.After follow-up for six months,the virology and serology remained stable.In contrast,none of the other 155 patients had demonstrated evidence of HBV infection or HBV reactivation.Conclusion The kinetics of HBV viral loads should be carefully monitored in patients with inflammatory arthritis and HBsAg-positive during anti-TNFα therapy.HBV reactivation should be treated with antiviral medicine through out the period of anti-TNFα therapy.
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Objective To investigate the application of secondary prevention medication for patients with high risk of recurrent ischemic stroke in Changzhou city,analyze the reasons for decreased medication compliance,and evaluate the current secondary prevention medication.Methods We investigated 300 consecutive hospitalized patients with acute non-cardiogenic and ischemic stroke high risk.High risk of recurrent stroke was defined as ESSEN Stroke Risk Score (ESRS) ≥3.Different ESRS scales consisting of different parameters were analyzed.All of the patients received standard secondary prevention of ischemic stroke at discharge.After three months and a year follow up,antiplatelet therapy,therapy of risk factors (hypertension and diabetes mellitus),lipid lowering therapy,and medication compliance were investigated.Results Except for age (x2 =126.54,P =0.000) and previous cerebral ischemic stroke or transient ischemic attack (TIA) (x2 =21.27,P =0.000),there were no significant differences in other risk factors (hypertension,diabetes,previous myocardial infarction,heart diseases,smoke) in patients with different ESRS scale scores (all P＞ 0.05).Antiplatelet therapy utilization was 98.3％ (295/300),antihypertensive and antidiabetic drug use rates were 95.0％(255/268) and 100％(72/72),statin use rate reached to 99％ (297/300) at discharge.After three months follow up,medication compliance in hypertension and diabetes mellitus therapy was the best [88.1％(222/252)and 86.2％ (56/65)],followed by aspirin [82.0％ (228/278)],and clopidogrel [6.1％ (17/278)].The medication compliance in lipid lowering therapy was the worst [60.1％ (167/278)].After a year follow-up versus the previous three-month follow-up,the medication compliance in hypertension and diabetes mellitus therapy was increased,but had no significant difference [89.9 ％ (220/245) vs.88.1％ (222/252),93.4％(57/61)vs.86.2％(56/65),P＞0.05],and the medication compliances inantiplatelet therapy with aspirin and clopidogrel,and lipid lowering therapy were increased significantly [93.2％ (245/263)vs.82.0％ (228/278),30.8(81/263) vs.6.1％ (17/278),88.9％ (234/263) vs.60.1％ (167/278),all P＜0.01].The increment of use rate was higher in clopidogrel therapy than in aspirin therapy.Conclusions The secondary prevention medication achieves certain efficacies in patients with high risk of recurrent ischemic stroke in changzhou city.Long term follow-up and good communication between doctor and patient can effectively improve the medication compliance in secondary prevention,and can increase the use rate of antiplatelet therapy in patients with high risk of recurrent ischemic stroke.
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Objective To re-evaluate the diagnoses of ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA) and analyze the incidence and reason of misdiagnosis.Methods Patients who were previously diagnosed as AS and nr-axSpA before referrals to Peking Union Medical College Hospital (PUMCH) were re-evaluated by three rheumatologists of PUMCH according to the modified New York criteria for AS and Assessment of SpondyloArthritis international Society (ASAS) axial SpA classification criteria for nr-axSpA.Results Totally 87 prior AS patients and 53 prior nr-axSpA patients were enrolled in this study.After re-evaluation,57 patients were still diagnosed as AS and 16 patients were still diagnosed as nr-axSpA.The misdiagnosis incidences were 34.48％ and 69.81％,respectively.The misdiagnosis incidence of nr-axSpA was higher than that of AS (P ＜ 0.01).Conclusions The misdiagnosis of AS were mainly due to the misjudgment of sacroiliac joints by CT.The misdiagnosis of nr-axSpA were mainly due to the misjudgment of sacroiliac joints by magnetic resonance imaging.Moreover,the misuse of ASAS axial SpA classification criteria contributed to the misdiagnosis also.
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Objective To investigate the effect of plasma fibrinogen (Fib) level on stroke recurrence within one year of first-ever ischemic stroke.Methods The patients with first-ever acute ischemic stroke were enrolled prospectively and were followed up for at least one year.They were divided into either a recurrent group or a non-recurrent group.Multivariate logistic regression analysis was used to explore the risk factors for stroke recurrence within one year of first-ever ischemic stroke.According to the plasma Fib levels of the early onset,the patients were divided into a high Fib group and a normal Fib group.Kaplan-Meier survival analysis was used to compare the recurrence between the two groups.Results A total of 121 patients with first-ever acute ischemic stroke were enrolled,111 completed one year follow up,and 30 of them (27.027％) had recurrent stroke.Multivariatelogistic regression analysis showed that the increased plasma Fib level (odds ratio [OR] 13.238,95％ confidence interval [CI] 1.152-152.077; P=0.038),older at the first onset (OR 1.321,95％ CI1.064-1.641;P=0.012),high body mass index(OR 1.351,95％ CI 1.001-1.823; P=0.049),and poor compliance of antiplatelet drugs (OR 36.819,95％ CI 1.890-717.143; P=0.017) and antihypertensive drugs (OR 50.765,95％ CI 3.198-805.878; P =0.005) were the dependent the risk factors for stroke recurrence within one year of first-ever ischemic stroke.Kaplan-Meier survival function curves showed that the recurrence rate of stroke in the high Fib group was significantly higher than that in the normalFib group (Log-rank test,P =0.000).Conclusions The increased high plasma Fib level,advanced age,obesity,as well as poor compliance of antiplatelet drugs and antihypertensive drugs were the independent risk factors for stroke recurrence within one year of first-ever ischemic stroke.
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Objective To enhance the understanding of hemophagocytic syndrome(HPS)by analyzing the clinical manifestations, diagnosis and therapy. Methods The clinical data of 12 patients with HPS were retrospectively collected in the People's Hospital of Jiangsu Province from 2000 to 2007. The relevant literature were reviewed. Results Twelve patients were diagnosed as secondary hemophagocytic syndrome most secondary to virus and bacteria infection. Some patients condition was associated with systemic lupus erythematosus or histiocytic necrotizing lympheadenitis. All of the 12 patients had high fever, abnormal liver function and showed a decrease in the number of blood cells in a short time. After antivirus and antibiotic treatment, 11 patients'condition were improved and 1 patient died. Conclusion Hemophagocytic syndrome is not a common clinical condition but with poor prognosis. When patient presents with fever without apparent reasons and pancytopenia, bone marrow examination should be done and sometimes repeated bone marrow examinations are needed. The diagnosis of secondary haemophagocytic syndrome needs multidisciplineary cooperation. Aggressive diagnostic procedures are needed to clarify the diagnosis and prompt treatments are warranted to improve prognosis.