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Objective:To investigate the correlation of blood pressure variability within 24 h after thrombolysis with symptomatic intracerebral hemorrhage (sICH) and 90 d outcome in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke treated with recombinant tissue plasminogen activator in the Department of Neurology, Jinshan Branch, Shanghai Sixth People's Hospital from January 2017 to May 2019 were enrolled prospectively. The baseline data of the patients were collected. The patients were divided into sICH group and non-sICH group according to the changes of head CT and the National Institutes of Health Stroke Scale (NIHSS) score after thrombolysis. At 90 d after thrombolysis, the modified Rankin scale was used to evaluate the outcomes, and the patients were divided into a good outcome group (0-2) and a poor outcome group (3-6). The blood pressure within 24 h after thrombolysis was monitored and the parameters related to blood pressure variability in 5 time periods (0-2 h, 2-6 h, 6-12 h, 12-18 h, and 18-24 h) were calculated, including systolic blood pressure (SBP) and diastolic blood pressure (DBP) maximum (max), minimum (min), maximum and minimum difference (max-min) and mean (mean). The differences between the adjacent blood pressures were calculated, the standard deviation (SD), successive variation (SV), rise successive variability (SVrise), drop successive variability (SVdrop), the maximum squared difference in blood pressure rise (SVrisemax), the maximum squared difference in blood pressure drop (SVdropmax) were calculated and recorded, respectively. Multivariate logistic regression analysis was used to evaluate the effect of various blood pressure variability parameters on sICH and the outcomes after intravenous thrombolysis. Results:A total of 112 patients receiving intravenous thrombolysis were included in the study. Their median age was 71 years (range, 38-92 years), 66 were males (58.9%); median baseline NIHSS score was 10. Seventeen patients (15.2%) developed hemorrhagic transformation, 10 of them (8.9%) were sICH. The 90-d follow-up showed that 73 patients (65.2%) had a good outcome, 39 (34.8%) had a poor outcome and 7 of them (6.3%) died. There were significant differences in hypertension ( P=0.029), ischemic heart disease ( P=0.012), total cholesterol ( P=0.033), baseline NIHSS score ( P=0.003) between the sICH group and the non-sICH group. There were significant differences in age ( P=0.025), gender ( P=0.005), atrial fibrillation ( P=0.003), etiologic classification of stroke ( P=0.003), baseline NIHSS score ( P<0.001) and sICH ( P=0.003) between the poor outcome group and the good outcome group. In addition, there were significant differences in multiple blood pressure variability parameters among the above groups (all P<0.05). Multivariate logistic regression analysis showed that DBP SVdropmax, 6-12 h DBP SV, 12-18 h DBP SV, 6-12 h DBP SVdrop, 12-18 h DBP SVdrop were the independent risk factors for sICH after intravenous thrombolysis (all P<0.05); 2-6 h SBP SV, 2-6 h SBP SVrise, 2-6 h SBP SVdrop, 2-6 h DBP SV, 2-6 h DBP SVrise and 2-6 h DBP SVdrop were the independent risk factors for poor outcome after intravenous thrombolysis (all P<0.05). Conclusions:Early blood pressure and some blood pressure variability parameters are closely related to sICH and outcomes after intravenous thrombolysis in acute ischemic stroke. Closely monitoring of blood pressure and its variability can help clinical management and outcome prediction after intravenous thrombolysis.
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BACKGROUND: Many animal and clinical studies have reported that the safe and effective usage of umbilical cord blood-derived mesenchymal stem cells (UCB-MSCs) transplantation for treatment of neurological genetic diseases.OBJECTIVE: To investigate the feasibility and effect of UCB-MSCs transplantation in the treatment of spinal muscular atrophy (SMA).METHODS: A child admitted at January 2010 had been confirmed as having SMA, and drug and rehabilitation therapies were invalid. Then, the child received UCB-MSCs transplantation via the first intravenous infusion and three times of subarachnoid injection, once a week, (4-6)×107 cells once and four times as a course. Neurological physical examination, biochemical test, muscle enzymes detection, FIM scoring and electromyography (EMG) examination were conducted. RESULTS AND CONCLUSION: Compared with prior to transplantation, the level of muscle enzymes decreased, FIM scores were increased from 68 to 93 points, EMG results showed that the motor units with re-contraction in each 10.0 ms were increased that the motor function was improved, the lower extremity muscle strength elevated, and the self-care ability was improved in the SMA child at 6 months after transplantation. During the 10-month follow-up, the child had no adverse effects. It is indicated that UCB-MSCs transplantation is effective to treat SMA, and the neurological function has a remarkable restoration.
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Objective To observe the clinical therapeutic effect of hyperbaric oxygen (HBO) therapy and swallowing training combined with Fengchi acupoint acupuncture on dysphagia caused by pseudobulbar paralysis after stroke. Methods Seventy-five patients were randomly divided into control group, HBO therapy group, swallow training group, acupuncture group and combined treatment group (n = 15). Patients in all groups were given cerebro-vascular disease routine treatment. In addition, the patients in HBO therapy group, swallowing training group and ac-upuncture group were given HBO therapy, swallowing training and Fengehi (GB20) acupoint acupuncture simultane-ously, respectively. The patients in combined treatment group were given HBO therapy combined with swallowing training and Fengchi acupoint acupuncture. Modified Kubota-Chiari's swallowing functional classification was used to assess swallowing function before and on the 3rd d,6th d,9th d, 12th d, 15th d, 18th d and 21st d after treatment. Results It was shown that the patients in all groups but the control group got significant improvement in swallowing after treatment, as demonstrated by the swallowing function scores (P < 0.05). Moreover, the priority order in im-provement of swallowing function and recovering rate were: combined treatment group > acupuncture group > swal-low training group > HBO therapy group > control group(P < 0.05). Conclusion The combination of HBO ther-apy, swallowing training and Fengchi acupoint acupuncture could act synergically to ameliorate dysphagia caused by pseudobulbar paralysis after stroke.
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@#Objective To observe the effect of hyperbaric oxygen,rehabilitation training or acupuncture at Fengchi acupoint on pseudobulbar paralysis after stroke.Methods 90 patients were divided into group Ⅰ(A,B,C) or Ⅱ(A,B,C) randomly.Patients in all groups were given conventional therapy,while those in groups ⅠB and ⅡB were given hyperbaric oxygen,ⅠC and ⅡC were given swallowing training and group Ⅱ was given acupuncture at Fengchi acupoint additionally.They were assessed with Modified Kubota-Chiari's swallowing functional classification before and after treatment.Results In all groups except ⅠA,swallowing function scores improved after treatment significantly(P<0.05).The scores were different significantly between group Ⅰ and group Ⅱ after treatment(P<0.05).Except 3 d after treatment,the scores were different significantly between sub-group of group Ⅰ or group Ⅱon other time points(P<0.05).Conclusion The hyperbaric oxygen is more effective than conventional therapy on pseudobulbar paralysis,but less than swallowing training.Acupuncture at Fengchi acupoint can improve their efficacy.
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Objective To compare the cerebral vessels stenosis in acute cerebral infarction patients with or without diabetes mellitus.Methods Using case-control study,51 acute cerebral infarction patients with diabetes mellitus and 64 patients without diabetes mellitus were checked by digital subtraction angiography(DSA).The condition of stenosis and obstruct of vessels in intracranial and extracranial were compared.Results Stenosis of intracranial arteries was frequent in both two groups.The main involved arteries included M1 and M2 segments of middle cerebral artery and external cranial segment of internal carotid artery.The rate of cerebrolvascular abnormality in the patients with diabetes mellitus(84.31%) was higher than that in the patients without diabetes mellitus(70.31%).Stenosis of multiple arteries(52.94%),arteriostenosis combined with ulcer or plaque(39.21%) and collateral circulation development(11.63%) were found in diabetic patients,while the rates were 18.75%,17.19% and 31.11%,repectively,in non-diabetic patients.These differences between two groups were statistical significances(all P
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Objective To observe the feasibility and safety of carotid artery stenting(CAS) for treating the patients with symptomatic carotid artery stenosis.Methods 60 patients who were diagnosed with symptomatic carotid artery stenosis by DSA were performed CAS.Among them, 52 cases were onset stenosis of carotid artery,8 cases were extracanical stenosis.The degree of stenosis was 50%～70% in 14 patients,70%～90% in 28 patients and≥90% in 18 patients.64 stents were placed,and 15 filter protection devices were used.Results The drgree of stenosis was decreased from (73.4?9.5)% to (12.5?8.2)%. The plaques were disappear in 53 cases, many debris were found in 5 filter protection divices. The clinical symptoms of all patients were disappear within one week, the mild paralyse was recover in all patients. There were 53 cases with heart rate slowdown during or after operation,the blood pressure declined in 48 cases,and there were 5 patients with vasospasm, as well as one case with cerebral embolization,one case with sydrome of high perfusion and one case with sydrome of low perfusion or swoon. During flowing up for 3 months to 2 years,no one case was found TIA or cerebral infarction,however,only one case was found mild restenosis by DSA.Conclusions CAS is a safety and efficient method for treatment symptomatic carotid artery stenosis. Lowering the risk of operation is done by handling indication seriously and operation skillfully.