ABSTRACT
Objective To investigate the correlations of serum total bilirubin level with infarct volume,severity and etiological typing in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to hospital from January 2012 to January 2014 were used as subjects of study.Their clinical and imaging data were collected,and serum total bilirubin levels were detected.The correlations of the serum total bilirubin levels with the infarct volume,severity and etiological typing were analyzed.Results A total of 290 patients with acute ischemic stroke were enrolled in the study.The patients were divided into either a large infarction group (≥1.8 cm3,n =145) or a small infarction group (＜ 1.8 cm3;n =145)according to the median cerebral infarction volume.The total bilirubin level of the large infarction group was significantly higher than that of the small infarction group (16.896± 7.761 μmol/L vs.13.039±4.477 μmol/L;t =5.185,P ＜ 0.001).Multivariate logistic regression analysis showed that the bilirubin highest quantile group (＞ 17.893 μmol/L) was an independent risk factor for large infarction (odds ratio [OR] 2.754,95％ confidence interval [CI] 1.028-7.375;P =0.044).According to the National Institutes of Health Stroke Scale (NIHSS) score,the patients were divided into a mild stroke group (NIHSS score ＜8;n =210) and a moderate to severe stroke group (NIHSS score≥ 8,n =80).The total bilirubin level of the moderate to severe stroke group was significantly higher than that of the mild stroke group (16.861 ±7.689)μmol/L vs.14.246 ± 6.019 μmol/L;t =3.052,P =0.002).Multivariate logistic regression analysis showed that the total bilirubin level was not an independent risk factor for moderate to severe stroke.Small artery occlusive stroke,large artery atherosclerotic stroke,and other definite causes of stroke were combined into non-cardioembolic stroke group (n =244).The total bilirubin level in the cardioembolic stroke group (n=46) was significantly higher than that in the non-cardioembolic stroke group (19.639±8.409 μmol/L vs.14.087 ±5.831 μmol/L;t =5.479,P＜0.001).Multivariate logistic regression analysis showed that the bilirubin highest quartile group (＞ 17.893 μmol/L) was an independent risk factor for cardioembolic stroke (OR 8.405,95％ CI 1.719-41.106,P =0.009).Conclusions The increased serum total bilirubin level is an independent risk factor for larger infarction and cardioembolic stroke.As an oxidative stress index,serum total bilirubin in acute stage can provide help for early identification of infarct volume and etiological subtype in patients with ischemic stroke.
ABSTRACT
Objective To investigate the relationship between serum neuron-specific enolase (NSE) level and the severity of brain injury in patients with acute ischemic stroke. Methods A total of 100 patients with acute ischemic stroke, classified as total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), posterior circalation infarct (POCI) and lacunar infarct (LACI) were included in this study. The serum levels of NSE were detected and cerebral infarc-tion volumes were measured using 32-bit OsiriX imaging software. The correlation between serum level of NSE, cerebral in-farction volume and subtypes of ischemic stroke was analyzed. Results Patients were divided into NSE≤11.46μg/L group and NSE>11.46μg/L group. The scores of NIHSS[6.0(4.0, 10.0) vs 4.0(2.0, 6.0)]were higher, the infarction volumes[4.3 (1.3, 15.9) cm3 vs 0.8(0.4,4.3) cm3]were larger in NSE>11.46μg/L group (P<0.05). The serum NSE level showed statistical-ly significant difference between TACI and other groups (P<0.01). The increased serum NSE level was correlated with in-creased infarction volume (rs=0.417,P<0.01). There was a linear regression between serum NSE level and infarction vol-ume. Its linear regression equation was =2.438+0.100 X (X:infarction volume;Y:serum NSE level). Conclusion The se-rum NSE level may be helpful for the prediction of the severity of brain injured in patients with acute ischemic stroke.
ABSTRACT
Objective To investigate the correlations of plasma brain natriuretic peptide (BNP) levels and the subtypes and the severity of acute ischemic stroke.Methods Consecutive patients with acute ischemic stroke were enrolled in the study.They were divided into large-artery atherosclerosis (LAA),smallartery occlusion (SAO) and cardioembolism (CE) according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification.Electrochemiluminescence immunoassay was used to measure plasma BNP.OsiriX software was used to calculate the cerebral infarction volume of MRI.Results A total of 159 patients with acute ischemic stroke were enrolled.Compared to the CE group,there were significant differences in the proportions of hyperlipidemia,atrial fibrillation,BNP ＞ 100 ng/L,and in the levels of lowdensity lipoprotein cholesterol (LDL-C) and BNP,as well as in the National Institutes of Health Stroke Scale (NIHSS) score and the infarct volume in the groups of LAA and SAO (all P ＜0.05).Multivariate logistic regression analysis showed that atrial fibrillation (odds ratio [OR] 148.638,95％ confidence interval [CI]17.532-1 260.182; P ＜ 0.001) and BNP ＞ 100 ng/L (OR 3.490,95％ CI 1.033-11.789; P =0.044)were the independent risk factors for CE ischemic stroke.Receiver operating characteristic curve analysis showed that the optimal cutoff value for predicting plasma BNP level of the CE ischemic stroke was 101.4 ng/L,and its sensitivity,specificity,positive predictive value,and negative predictive values were 80.56％,76.42％,50.00％,and 93.07％,respectively.The optimal cutoff value was used as a boundary,the patients were divided into a BNP ≤ 101.4 ng/L group and a ＞ 101.4 ng/L group.The proportions of males (P=0.031),hyperlipidemia (P=0.002) and smoking (P =0.026),as well as the levels of total cholesterol (P=0.020),triglyceride (P=0.024) and LDL-C (P=0.013) were significantly lower than those in the BNP ≤ 101.4 ng/L group,while the proportions of patients with ischemic heart disease (P ＜0.001) and atrial fibrillation (P＜0.001),as well as the NIHSS score and the infarct volume were significantly higher and larger than those in the BNP ≤ 101.4 ng/L group.Spearman rank correlation analysis showed that the plasma BNP levels were significantly negatively correlated with the triglycerides (r=-0.224,P=0.004) and LDL-C (r=-0.170,P=0.032) levels,and were significantly positive correlated with the NIHSS scores (P=0.167,P=0.044) and the infarct volume (P=0.281,P＜0.001).Conclusions Plasma BNP level can be used as a biological marker for early differentiating CE from non-CE ischemic stroke,as well as identifying the severity of stroke.
ABSTRACT
Objeaive To investigate the impact of serum uric acid concentration on short-term outcome in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were collected.According to the modified Rankin scale (mRS) scores at discharge,the patients were divided into either a good outcome group (mRS score 0 to 2) or a poor outcome group (mRS score 3 to 6).The baseline National Institutes of Health Stroke Scale (NIHSS) scores,serum uric acid (SUA) levels and other demographic and clinical data in both groups were compared.Results A total of 311 patients with acute ischemic stroke were enrolled in the study.There were 185 patients in the good outcome group and 126 in the poor outcome group.The patients' constituent ratios of the baseline NIHSS scores (median [interquartile range]) (7 [4-11] vs.3[2-4] ; Z =9.858,P =0.001),previous type 2 diabetes mellitus (29.4％ vs.14.1％ ;x2 =10.877,P =0.001) and history of TIA (27.8％ vs.17.8％ ;x2 =4.335,P =0.037) were significantly higher than those in the poor outcome group,while the patients' constituent ratio of the SUA levels (331.984±118.995 mmol/Lvs.363.276±100.743 mmol/L;t =2.497,P=0.013) and the NIHSS score ＜9 (63.5％ vs.96.8％ ;x2 =59.562,P =0.000) were significantly lower than those in the good outcome group.The baseline NIHSS and mRS scores at discharge were higher in the SUA lower quartile group (all P ＜0.01).Multivariate logistic regression analysis showed that the increased SUA was an independent protective factor for short-term outcome in patients with acute ischemic stroke (odds ratio 0.997,95％ confidence interval 0.995-0.999; P =0.016).Conclusions The increased SUA is an independent protective factor for short-term outcome in patients with acute ischemic stroke.
ABSTRACT
Objective To screen and analyze nucleotide variants in 5'-untranslated region(5'-UTR)in voltage-gated sodium channel α1-subunit gene(SCN1A)in patients with Dravet syndrome and to evaluate the association of the variants with disease.Methods Peripheral blood of 24 patients with Dravet syndrome and 100 unrelated normal persons were collected and genomic DNA was extracted.PCR-sequencing of SCN1 A 5'-UTR in these DNA was performed.To evaluate the possibility of mutation inducing disease,bioinformatics analysis was applied to analyze the conservation of the sequences around the mutation site and predict the potential transcription elements.Results The nucleotide variant of 166.642.520G→A in exon 2 was identified in two patients,but not in normal controls.The mutation was a de novo mutation in a patient with early-onset.In the second proband,the mutation was also carried by his clinically asymptomatic mother.The nucleotide site 166.642.520 was moderately conserved in mammals(62.5%).The average nucleotide identity rate between human and other mammals species in the region adjacent to 166.642.520 was 88.5%.Two potential transcription regulatory elements were predicted on the sequence with the mutation of 166.642.520G>A,and only one on the sequence with wild-type.Conclusions The mutation 166.642.520G>A may be associated with Dravet syndrome and further studied should be performed to verify it and demonstrate its pathogenic mechanisms.
ABSTRACT
Objective To compare the antalgic effects of ropivacaine in various doses on brachial plexus nerves. Methods 87 patients undergoing upper arm surgery were enrolled in this study. The patients were unpremed-itated. The patients were randomized to receive ropivacaine of 0.30,0.25 or 0.20% (group Ⅰ,Ⅱ and Ⅲ) with mor-phine of 0.1mg/ml and Lidocaine of 10mg/ml. In order to analygesia of brachial plexus nerves,the rejecting of load dose is firstly 10ml,the total dose is 10ml/24h interval every time,the antalgic time is about 50 hours. To compare the antalgic effects of ropivacaine in various doses based on standard of VAS. Based on standard of Bromage to assess the situation of motor neuron blocking. Results According to standard of VAS in 6,12,24 and 48 hours after underwent surgery, the group Ⅲ is more effective than group Ⅰ and group Ⅱ ; according to standard of Bromage, the group Ⅰ is more effective than group Ⅱ and group Ⅲ. it has no adverse reactions to patients. Condusion 0. 25% of ropiva-eaine with morphine of 0.1mg/ml and lidocaine of 10mg/ml have obtained good antalgic effects for patients after un-dergoing upper arm surgery,it is fit for applying in clinic.
ABSTRACT
Objective To summarize the causes and re-surgical methods of early intracranial hypertension in- duced by operation in meningeal neoplasms. Methods Analysize the re-surgical materials about the early intracranial hypertension induced by operation in meningeal neoplasms of 16 cases. Results The formation of hematoma or the appearance of tension injury after the surgery of meningeal neoplasms was related to the location and quality of the tumor. The reasons for these were as follows. The tension injury often happens in 48 ～ 72h after surgery. The time needed by the operation of hernatoma is changeable. The decreasing level of consciousness was the major expression of intracranial hypertension after surgery. Conclusion Watch the conditions of meningeal neoplasms after operation. Do the image examination if needed. So it is easy the final and deal with the hematoma or the cerebral edema.