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Intravenous thrombolysis is an effective treatment for acute ischemic stroke, but its benefits are time-dependent. The time from onset to intravenous thrombolysis is divided into onset-to-door time (ODT) and door-to-needle time (DNT). The former reflects pre-hospital delay, while the latter reflects in-hospital delay and can be controlled by stroke improvement plan. This article reviews the influence of DNT on clinical outcomes, the influencing factors of DNT and the stroke improvement plan to shorten DNT.
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Carotid atherosclerotic plaque rupture and thrombosis are the independent risk factors of acute ischemic cerebrovascular disease. Early identification of vulnerable plaques provides the evidence for early intervention in patients with asymptomatic carotid artery stenosis, and also helps to reduce the recurrence risk in patients with symptomatic carotid artery stenosis. This article focuses on comparing the advantages and limitations of the available clinical imaging methods in identifying vulnerable carotid artery plaque, and provides relevant prognostic indicators for patient risk stratification in clinical work.
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Human coronavirus OC43 (HCoV-OC43) and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) belong to the β-coronavirus genus. Since the discovery in 1967, HCoV-OC43 has been continuously circulating in human population and has become one of the common seasonal respiratory viruses. SARS-CoV-2, which has a higher morbidity and fatality rate, appeared at the end of 2019, followed by the emergence of a variety of variants, and the transmission and infection capacity of SARS-CoV-2 has been enhanced. HCoV-OC43 may be similar to SARS-CoV-2 in terms of genomic structure and function, species evolution, epidemic characteristics and clinical manifestations. In this review, the epidemiology, genomics, phylogenetic evolution and other aspects of HCoV-OC43 and SARS-CoV-2 were analyzed. Such an analysis would be helpful to understand the association and differences between the two viruses, and provide reference for understanding the potential threats of HCoV-OC43.
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Objective To investigate clinical characteristics of elderly patients with sepsis combined with congestive heart failure and risk factors for short-term mortality.Methods Clinical data of elderly patients with sepsis combined with congestive heart failure who were admitted in our hospital from January 2013 to January 2018 were selected and retrospectively analyzed.They were divided into the survival group(n=134)and the death group(n=83)according to survival status during hospitalization.The clinical characteristics and risk factors for mortality were analyzed and compared.Results A total of 217 elderly patients were enrolled,with 113 males and a mean age of(72.3 ± 7.5)years.The death rate of sepsis was 38.3％ (83/217 cases),and 29 cases died of sepsis and 54 cases died of other diseases.Pneumonia accounted for 78.8％ (171/217 patients) in all patients of two groups,and skin and soft tissue infection for 12.9 ％ (28/217 cases).There were significant differences between two groups in age,body mass index,smoking,diabetes,chronic obstructive pulmonary disease,mean arterial pressure,arterial oxygen partial pressure(PaO2),C-reactive protein,white blood cell counts,neutrophil and lymphocyte counts,glomerular filtration rate,serum sodium level,albumin level,lactate level,and left ventricular ejection fraction(P ＜0.05).Furthermore,the rates of invasive mechanical ventilation and continuous renal replacement therapy were higher in the death group than in the survival group(x2=13.209 and 7.402,P＜0.001 and 0.007).Multivariate Cox regression analysis showed that advanced age,chronic obstructive pulmonary disease,low albumin level and low glomerular filtration rate were risk factors for mortality(P＜0.05).Conclusions Elderly patients with sepsis combined with congestive heart failure often have severe pneumonia and violent skin and soft tissue infection,with worse heart and renal function.Advanced age,chronic obstructive pulmonary disease,low albumin level and low glomerular filtration rate are risk factors for mortality.
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Objective@#To investigate the causes and clinical manifestation of adverse reaction of articaine hydrochloride and epinephrine tartrate injection.@*Methods@#A retrospective analysis was conducted on the adverse drug reactions (ADR) of local anesthetic articaine hydrochloride and epinephrine tartrate injection.@*Results@#In 75 cases of adverse reactions, there were 40 cases of female and 35 cases of male. Adverse reactions occured more frequently at the age of 3-10 [33% (25/75)] and 1-10 min and one day after injection, respectively accounting for 20% (15/75), and two days, accounting for 15% (15/75), 10-21 days accounting for 8% (6/75). The main manifestations were injection site ulcers, followed by skin reactions such as pain, swelling, necrosis and pruritus at the injection site.@*Conclusions@#The main adverse reactions of articaine hydrochloride and epinephrine tartrate injection are the injection site ulceration, followed by injection site pain, rash, pruritus and drowsiness, nausea and dizziness, palpitations, sweat and hypotension. Doctors should ask the medical history in detail and pay close attention to the patient's medication safety.
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Objective To investigate the effect of serum uric acid level on outcomes after intravenous thrombolysis in patients with acute ischemic stroke. Methods From April 2014 to January 2018I, patients with acute ischemic stroke received intravenous thrombolysis at the stroke unit of Shenzhen Second People's Hospital were enrolled retrospectively. The clinical outcomes were assessed according to the modified Rankin scale at 3 months after onset, > 2 were defined as poor outcome. The demographic and clinical data were compared between the good outcome group and the poor outcome group. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcomes. Results A total of 155 patients were enrolled, including 92 (59. 4％) in the good outcome group and 63 (40. 6％) in the poor outcome group. The serum uric acid level in the good outcome group was significantly higher than that in the poor outcome group (365. 465 ±100. 055 μmol/L vs. 325. 958 ±114. 704 μmol/L; t = -2. 227,P = 0. 027). Multivariate logistic regression analysis showed that there was a significant positive correlation between low serum uric acid levels and poor outcomes (They were divided into 4 levels according to the quantiles. ≥416. 01 μmol/L as reference; 350. 11- 416. 00 μmol/L: odds ratio [ OR ] 1. 414, 95％ confidence interval [CI] 0. 375-5. 339, P = 0. 609; 278. 61-350. 10 μmol/L: OR 3. 020, 95％ CI 0. 878- 10. 390, P = 0. 080; ≤ 278. 60 μmol/L: OR 4. 194, 95％ CI 1. 194-14. 726, P = 0. 025; trend test P =0. 013]. Conclusion Higher serum uric acid level is independently associated with good outcomes after intravenous thrombolysis in patients with acute ischemic stroke.
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Objective To evaluate the role of spinal nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling pathway in hydrogen-induced reduction of inflammatory pain in rats.Methods Sixty-four SPF healthy adult male Sprague-Dawley rats,weighing 200-250 g,were divided into 4 groups (n =16 each) using a random number table:control group (group C),inflammatory pain group (group IP),inflammatory pain plus hydrogen-rich saline group (group IP+H2) and inflammatory pain plus hydrogen-rich saline plus Nrf2 inhibitor all-trans retinoic acid (ATRA) group (group IP+H2+ATRA).Chronic inflammatory pain was induced by injecting complete Freund's adjuvant (CFA) 100 μl into the plantar surface of the left hind paw in IP group and IP+H2 group.The equal volume of normal saline was given instead in group C.Hydrogen-rich saline 5 ml/kg was injected intraperitoneally once a day for 7consecutive days starting from 1 day after injecting CFA in group IP+H2 and group IP+H2+ATRA,and the equal volume of normal saline was given instead in the other groups.ATRA 7 mg/kg was injected intraperitoneally once a day for 2 consecutive days starting from 2 days before injecting CFA.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before establishing the model (T0) and 1,3 and 7 days after establishing the model (T1-3).Six rats were sacrificed after the last measurement of pain threshold on day 7 after establishing the model,and the L4-6 lumbar segments of the spinal cord were removed for determination of the expression of Nrf2,HO-1 and glial fibrillary acidic protein (GFAP) by Western blot.Results Compared with group C,the MWT was significantly decreased and the TWL was shortened at T1-3,and the expression of Nrf2,HO-1 and GFAP was up-regulated in IP and IP+H2 groups (P＜0.05).Compared with group IP,the MWT was significantly increased and the TWL was prolonged at T1-3,the expression of Nrf2 and HO-1 was up-regulated,and the expression of GFAP was down-regulated in group IP+H2 (P＜0.05),and no significant change was found in the parameters mentioned above in group IP+H2+ATRA (P＞0.05).Compared with group IP+H2,the MWT was significantly decreased and the TWL was shortened at T1-3,the expression of Nrf2 and HO-1 was down-regulated,and the expression of GFAP was up-regulated in group IP+H2+ATRA (P＜0.05).Conclusion Activation of spinal Nrf2/HO-1 signaling pathway is involved in hydrogen-induced reduction of infflammatory pain in rats.
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Objective To evaluate the relationship between the perfusion mode of neovascularization of carotid plaque in CEUS and the ischemic stroke in transient ischemic attack (TIA) patient.Methods A total of 73 TIA patients according to the inclusive criteria were enrolled.All the patients underwent routine carotid ultrasonic examination.And 61 patients with plaque thicker than 2.5 mm in carotid bifurcation underwent CEUS and follow-up for at least 18 months.All the patients were divided into recurrent and non-recurrent groups.Logistic regression analysis were performed to detect the risk factors for incurrence of ischemic stroke or recurrence of TIA in 18 months.Results There were statistical differences between 2 groups in hypertension,diabetes,hyperlipemia,smoking history,family history of stroke,medication compliance,two-dimensional ultrasound and CEUS characteristics (all P＜0.05).Multivariate Logistic regression analysis showed that all the factors correlated with the recurrency,from big to small order were the CEUS characteristics of carotid plaque,hypertension,medication compliance,diabetes,two-dimensional ultrasound characteristics of carotid plaque.Conclusion CEUS could evaluate the perfusion mode of neovascularization in carotid plaques.For TIA patients,CEUS could predict the incurrence of ischemic stroke or recurrence of TIA,which can guide TIA patients targeted prophylaxis of them.
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Objective To explore the prevalence and risk factors of stroke in a population over 40 years in a community in Shenzhen, China. Methods The subjects investigated were a population ≥40 years old in this cross-sectional study. Cluster sampling method was used to conduct the unified questionnaires, physical examination, and laboratory examination in the community residents, and then the survey data were used for online entry analysis. Results A total of 5 308 community residents were screened, and 160 experienced stroke. The crude prevalence of stroke was 3 014. 32/100 000. The prevalence of stroke increased with age, and that in males was significantly higher than that in females (3 721. 37/100 000 vs. 2 552. 93/100 000; χ2 = 5. 923, P = 0. 015). There were significant differences in the proportions of males, obvious overweight, hypertension, diabetes mellitus, atrial fibrillation, lack of physical activity, and family history of stroke, as well as age, systolic blood pressure, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and fasting glucose level between the stroke population and the non-stroke population (all P 80 years) in both males and females. The proportions of diabetes (P < 0. 001) and atrial fibrillation (P < 0. 001) in males, and obvious overweight (P = 0. 001) in females were gradually increased with age, and the proportion of smoking in males weas gradually reduced with age. The proportions of hypertension (P < 0. 001) and obvious overweight (P < 0. 001) in males were significantly higher than those in females at the age of 40 to 49 years. The proportions of hypertension (P < 0. 001), diabetes (P < 0. 001) and obvious overweight (P < 0. 001) in males were significantly higher than those in females at the age of 50 to 59 years. The proportion of hypertension in males was significantly higher than that in females at the age of 60 to 69 years (P = 0. 039). The proportions of hypertension (P = 0. 016), atrial fibrillation (P = 0. 028) and hyperlipidemia (P = 0. 023) in females were significantly higher than those in males at the age of 70 to 79 years. The proportion of obvious overweight in females was significantly higher than that in males at the age of ≥80 years (P =0. 001). Conclusions The crude prevalence of stroke is higher among the community residents. The the levels of exposure to stroke risk factors including hypertension, diabetes and atrial fibrillation are higher. It may be important to intervene on these risk factors in community residents, especially in elders and those with family history of stroke.
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Objective To investigate the characteristics of the depression during emotional processing.Methods 24 participants with first episode of depression and healthy controls were assessed with HAMD scale,using DTI to dectect values of white matter FA,and using fMRI with pictures of emotional stimuli;thus results related with imagings were produced.The results were statistically analyzed.Results The brain areas indicating FA values deference with statistial significance in depression patients compared with the control ones included:left and right frontal lobe (left frontal lobe depression group 0.324 ± 0.090,control group 0.467 ± 0.072,P ＜ 0.01),corpus callosum knee (depression group 0.614 ±0.146,control group 0.734 ±0.063,P＜0.01),anterior cingulate gyrus (depression group 0.222 ±0.035,control group 0.343 ±0.021,P＜0.01) ;the fronal FA values in depression grop were negatively correlated with the duration of bilateral frontal white matter (r =-0.555,P ＜ 0.01).The activation of emotional brain regions stimulated by pictures includes frontal cortex-subcortical reticular system,and the hypothalamus and limbic system.There was a significant difference between two groups.Conclusion There may be abnormal emotional processing dystunction in patients with depression.It may be the pathological basis to have frontal white matter fiber tracts broken.
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Objective To investigate the characteristics and relative pathogenesis of cognitive impairment in people with depression.Methods 24 people with depression and 24 healthy controls were evaluated respectively with HAMD scale,the WCST test,N-BACK task P300 and fMRI.Results (1) The WCST scores,N-back reaction (MRT),the P300 incubation period in depression group were significantly different from those in control group(P300 wave amplitude(4.12± 1.51) μV vs (6.42± 1.73) μV ; P300 latency(392.02±23.60) ms vs (309.43± 21.39) ms,t=4.922,P＜0.01 ; t=12.726,P＜0.01).(2) The illness course had positive correlation with Rep(r=0.596,P＜0.01) and mRT(r=0.518,P＜0.01).The P300 latency had positive correcation with Rpe(r=0.929,P＜ 0.01) and mRT(r=0.939,P＜0.01).(3)Compared with control group,the decreased activation area in patients with depression were as follows:bilateral frontal gyrus,left middle frontal gyrus,inferior frontal gyrus and superior parietal lobule.Conclusion The depressive patients exist cognitive impairment mainly in frontal lobe.The longer with the illness,the wose with the impairment.P300 incubation period is a sensitive indicator of the frontal executive function.
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In this paper, time courses of discrete cortical current sources evoked by target and distractor stimulus are presented in a visual three-stimulus oddball paradigm. 64-channel electroencephalogram (EEG) signals were recorded in healthy subjects in the paradigm where the P3b component of the P300 is evoked in the detection of rare events (target and distractor) and the P3a component is mainly produced by distractor events. A regional source model with constraints of spatial coordinates from fMRI was then applied to event-related potentials (ERPs) data in the target and distractor conditions. Activities of regional sources indicated bilateral inferior parietal lobe, posterior parietal cortex and inferior temporal cortex mainly contribute to the P3b, while the P3a was mainly produced by bilateral insula, bilateral precentral sulcus and cingulate gyrus. Target processing involved parietal lobe, inferior temporal cortex and left insula engaged in stimulus-driven attention process, goal-directed attention process, categorization of visual stimuli and memory retrieval, while distractor processing involved right insula and cingulate gyrus engaged in attention switching and reengagement of attention resource.
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Adolescent , Adult , Female , Humans , Male , Young Adult , Brain , Physiology , Electroencephalography , Event-Related Potentials, P300 , Physiology , Evoked Potentials, Visual , Physiology , Magnetic Resonance Imaging , Photic Stimulation , Methods , Visual Perception , PhysiologyABSTRACT
Objective To investigate whether there are correlations between working memory impairmentand fractional anisotropy values and to explore the neuropathology underlying that the patients of depression suffered from memory impairment.Methods Thirty depression patients and 30 healthy controls group-matched by age,educational level were conducted the study.Mean correct reaction time(mRT)was recorded when they performed a One-Back Working Memory Task and fractional anisotropy(FA)values was recorded when they performed the diffusion tensor imaging.Statistics analysis was done respectively for mRT and FA values between two groups.Results Relative to mean correct reaction time((612.45±54.08)ms)of controls,the mean correct reaction time ((720.25±57.02)ms)of patients with depression was much longer(P＜0.05)and the patients with depression had a lower FA values in the white matter of both frontal lobe,anterior cingulate gyrus,supramarginal gyrus,splenium of corpus callosum(P＜0.05),and the FA values in the white matter of both frontal lobe were significantly negative correlated with mRT(r=-0.604,P＜0.05).Conclusion The impairment of white matter region may be one of the neuropathology underlying that the depression patients suffer from memory impairment.