Evolution Patterns of 256 Cases of Chronic Kidney Disease with Kidney Yang Deficiency Syndrome Based on Data Mining / 中国实验方剂学杂志

ObjectiveTo analyze the characteristics of kidney Yang deficiency syndrome in different stages and time evolution of chronic kidney disease （CKD） to explore the evolution patterns of kidney Yang deficiency syndrome in CKD. MethodThe evidence information of 256 patients with CKD was collected from October 2020 to September 2022 according to relevant standards， and the "Kidney Yang Deficiency Syndrome Evaluation Scale for Chronic Kidney Disease" was developed. With SPSS Statistics 20.0， SPSS Modeler 18.0， Gephi 0.9.2， and R 4.2.1， the syndrome information of CKD patients at various stages and the syndrome changes after one year were statistically analyzed using complex network analysis， association rule analysis， probability transition matrix analysis， and chi-square test， and the kidney Yang deficiency syndrome of patients at various stages was comprehensively evaluated. ResultIn the CKD population， the proportion of females with kidney Yang deficiency syndrome was higher than that of males （P<0.01）， and the proportion of people over 65 years old was higher than in people under 65 years old. The proportion of people with kidney Yang deficiency syndrome increased with the progression of kidney disease， and the proportion of Ⅳ-Ⅴ CKD patients with kidney Yang deficiency syndrome was higher than that of Ⅰ-Ⅱ CKD patients （P<0.01）. From Ⅰ CKD to Ⅴ CKD， the frequency of dull tongue continued to increase， and the frequency of enlarged tongue and tooth-marked tongue continued to increase after Ⅲ CKD. The frequency of thick coating and greasy coating ranked in the top 3 of frequency distribution in Ⅴ CKD. After Ⅲ CKD， the top 3 tongue characteristics were weak pulse， deep pulse， and thready pulse， all of which were characteristics of kidney Yang deficiency syndrome. Complex network analysis of the tongue and pulse showed that the core tongue and pulse characteristics of patients with end-stage CKD were tooth-marked tongue with white coating and deep and thready pulse. The results of symptom frequency analysis and complex network analysis showed that aversion to cold and preference for warmth， weakness of the knees， and cold extremities were the top 3 symptoms in Ⅰ-Ⅲ CKD patients with kidney Yang deficiency syndrome， and in Ⅳ-Ⅴ CKD， the manifestations of the syndrome of Yang deficiency and water diffusion， such as drowsiness and fatigue， edema， and frequent urination at night became characteristic symptoms. The scores of edema， pale complexion， soreness and weakness of the waist and knees， loose stools， and mental depression symptoms， as well as the total score of kidney Yang deficiency syndrome gradually increased with disease progression， with statistical differences between different stages of CKD （P<0.05， P<0.01）. The frequency analysis of disease-related syndrome elements showed that the frequencies of Yang deficiency syndrome， phlegm-dampness syndrome， blood stasis syndrome， and turbidity-toxin syndrome gradually increased with disease progression， and there were statistically significant differences in the distribution between different stages of CKD （P<0.05， P<0.01）. The results of complex network analysis showed that Yang deficiency syndrome was the core syndrome element throughout all stages of CKD and was the main syndrome element type of CKD， while phlegm-dampness syndrome， blood stasis syndrome， and turbidity-toxin syndrome were gradually revealed in the middle and late stages of CKD. In the CKD population with kidney-Yang deficiency syndrome， the distribution of phlegm-dampness syndrome， blood stasis syndrome， and turbidity-toxin syndrome as concurrent syndromes in different CKD stages had statistically significant differences （P<0.05， P<0.01）. The association rule analysis showed that as the disease progressed， associations between the concurrent syndromes， such as phlegm-dampness syndrome， blood stasis syndrome， turbidity-toxin syndrome， and fluid retention syndrome， and kidney-Yang deficiency syndrome were gradually enhanced. The comparison of the changes in CKD with kidney Yang deficiency syndrome within one year showed that the disease location was centered on the kidney and transmitted between the spleen， stomach， heart， and liver. There is a 23.81% probability of kidney-Yang deficiency syndrome transforming into Qi deficiency syndromes （Qi deficiency in the spleen and kidney， Qi deficiency in the liver， and Qi deficiency in the heart）， 23.79% into Yin deficiency syndromes （Yin deficiency in the liver and kidney， Qi and Yin deficiency， and Yin deficiency in the liver and stomach）， and 9.52% into dampness syndromes （phlegm-dampness internal obstruction and wind-dampness obstruction）. In contrast， 20% of spleen and kidney Qi deficiency syndrome transformed into kidney Yang deficiency syndrome， and 33.33% of Qi deficiency and blood stasis syndrome transformed into kidney Yang deficiency syndrome. ConclusionAs Ⅰ CKD progresses to Ⅴ CKD， the severity of kidney Yang deficiency syndrome gradually increases， and the syndrome characteristics of kidney Yang deficiency become pronounced. Furthermore， the pathogenic factors， such as phlegm-dampness， blood stasis， and turbidity-toxin， gradually increase. With the change of time， kidney Yang deficiency syndrome in CKD tends to evolve into syndromes related to Qi deficiency， Yin deficiency， and dampness. The discovery of these rules provides a theoretical basis and reference guidance for the treatment of CKD based on syndrome differentiation.

Correlation between pre-stroke cognitive impairment and MRI markers in patients with minor acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the correlation between MRI markers of neurodegenerative diseases and vascular diseases and pre-stroke cognitive impairment (PSCI).Methods:Patients with minor acute ischemic stroke at first onset and aged ≥60 years admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University and the Department of Neurology, Linyi Jinluo Hospital from March 2019 to December 2021 were retrospectively enrolled. The imaging markers of cerebral small vessel disease and neurodegeneration were analyzed by dichotomy visual score. The former included cerebral white matter hyperintensities, vasogenic lacunar lesions, cerebral microbleeds, and enlarged perivascular space, and the latter included global cortical atrophy and medial temporal lobe atrophy. According to the score of Information Questionnaire on Cognitive Decline in the Elderly (IQCODE), the patients were divided into PSCI group (≥3.31 points) and non-PSCI group (<3.31 points). The clinical baseline data and MRI markers of both groups were compared. Multivariate logistic regression model was used to analyze the correlation between MRI markers and PSCI, and receiver operator characteristic (ROC) curve was used to analyze the predictive value of MRI markers to PSCI. Results:A total of 221 patients were enrolled in the study, including 77 patients (34.8%) in the PSCI group and 144 (65.2%) in the non-PSCI group. Univariate analysis showed that there were significant differences in age, years of education, pathological white matter hyperintensities, medial temporal lobe atrophy, and the proportion of patients with ≥1 abnormal MRI markers between the two groups (all P<0.05). Multivariate logistic regression analysis showed that older age (odds ratio [ OR] 1.089, 95% confidence interval [ CI] 1.034-1.146; P=0.001), years of education <6 years ( OR 3.134, 95% CI 1.534-6.401; P=0.002), medial temporal lobe atrophy ( OR 2.911, 95% CI 1.385-6.121; P=0.005), and presence of ≥1 abnormal MRI markers ( OR 2.823, 95% CI 1.305-5.938; P=0.007) were the independent risk factors for PSCI. ROC curve analysis showed that the area under the curve of medial temporal lobe atrophy and the presence of ≥1 abnormal MRI markers for predicting PSCI were both smaller (0.595 and 0.584 respectively), but the area under the curve was the largest when the two and years of education were combined (0.818, 95% CI 0.756-0.880; P<0.001), and its sensitivity and specificity for predicting PSCI were 79.9% and 71.4% respectively. Conclusions:The incidence of PSCI is high. Medial temporal lobe atrophy combined with other abnormal MRI markers has a certain predictive value for PSCI.

Correlations of Characteristics of Kidney Yang Deficiency Syndrome with Clinical Indicators and Risk Factors of Chronic Kidney Disease / 中国实验方剂学杂志

ObjectiveTo study the correlations of the characteristics of kidney Yang deficiency syndrome in patients with chronic kidney disease （CKD） with clinical indicators and to explore the risk factors of kidney Yang deficiency in CKD. MethodThe differentiation of traditional Chinese medicine （TCM） syndrome classified the 225 CKD patients who met the inclusion criteria into two groups： one group of kidney Yang deficiency syndrome （99 patients） and one group of non-kidney Yang deficiency syndrome （126 patients）. The symptoms， tongue manifestation， pulse manifestation， and accompanied symptoms of the kidney Yang deficiency syndrome group were recorded. The syndrome characteristics were summarized by factor analysis and clustering analysis. The levels of hemoglobin, red blood cell count, urinary protein, urinary glucose, creatinine, urea nitrogen and glomerular filtration rate were compared between the kidney Yang deficiency syndrome group, the non-kidney Yang deficiency syndrome group and the normal control group by ANOVA and non-parametric test. The binary logistic regression model was employed to analyze the correlations of lifestyle， body mass index （BMI） with syndrome. ResultThe high-frequency symptoms of CKD patients with kidney Yang deficiency syndrome were waist pain， fear of cold， favor of warm， lethargy， fear of cold at waist and knees， etc. The patients mainly presented deep pulse， thready pulse， or weak pulse， and the tongue with white coating， greasy coating， or thin coating. A total of 13 common factors were obtained， which can be classified into 5 categories. The patients with kidney Yang deficiency syndrome mainly had symptoms in limbs （especially lower limbs）， chest， bladder， fleshy exterior， and stomach， with the main manifestations of deficiency-cold， Qi deficiency， fluid retention， and blood stasis. The clustering analysis classified the patients into 11 categories， which reflected that kidney Yang deficiency syndrome mainly presented the symptoms of Qi deficiency， blood stasis， and fluid retention， with fleshy exterior， limbs， spleen， stomach， ears， mind， and bladder involved. The results of clustering analysis and factor analysis were consistent， both of which indicated that the patients were weak with deficiency-cold， accompanied by fluid retention and blood stasis. Frequency analysis also showed that common symptoms mainly included Qi deficiency， fluid retention， cold-dampness， and blood stasis. Compared with the non-kidney Yang deficiency group， the kidney Yang deficiency group showed a large proportion of patients in stage 3-5 CKD， elevated urea nitrogen （P<0.05）， decreased glomerular filtration rate， hemoglobin， and red blood cell count （P<0.05）， and increased qualitative grade of urine protein. In addition， the results of regression analysis showed that female， little or no exercise， and diet preference were the risk factors for kidney Yang deficiency syndrome in CKD （P<0.05）. ConclusionThe disease location and manifestations have correspondence in the CKD patients with kidney Yang deficiency syndrome. The TCM symptoms are correlated with clinical indicators. Hemoglobin， red blood cell count， glomerular filtration rate， urea nitrogen， and urine protein can reflect the connotation of kidney Yang deficiency syndrome in CKD to a certain extent. Additionally， related risk factors in life can affect the occurrence of kidney Yang deficiency syndrome in CKD.

Correlations of Characteristics of Kidney Yang Deficiency Syndrome with Clinical Indicators and Risk Factors of Chronic Kidney Disease / 中国实验方剂学杂志

ObjectiveTo study the correlations of the characteristics of kidney Yang deficiency syndrome in patients with chronic kidney disease （CKD） with clinical indicators and to explore the risk factors of kidney Yang deficiency in CKD. MethodThe differentiation of traditional Chinese medicine （TCM） syndrome classified the 225 CKD patients who met the inclusion criteria into two groups： one group of kidney Yang deficiency syndrome （99 patients） and one group of non-kidney Yang deficiency syndrome （126 patients）. The symptoms， tongue manifestation， pulse manifestation， and accompanied symptoms of the kidney Yang deficiency syndrome group were recorded. The syndrome characteristics were summarized by factor analysis and clustering analysis. The levels of hemoglobin, red blood cell count, urinary protein, urinary glucose, creatinine, urea nitrogen and glomerular filtration rate were compared between the kidney Yang deficiency syndrome group, the non-kidney Yang deficiency syndrome group and the normal control group by ANOVA and non-parametric test. The binary logistic regression model was employed to analyze the correlations of lifestyle， body mass index （BMI） with syndrome. ResultThe high-frequency symptoms of CKD patients with kidney Yang deficiency syndrome were waist pain， fear of cold， favor of warm， lethargy， fear of cold at waist and knees， etc. The patients mainly presented deep pulse， thready pulse， or weak pulse， and the tongue with white coating， greasy coating， or thin coating. A total of 13 common factors were obtained， which can be classified into 5 categories. The patients with kidney Yang deficiency syndrome mainly had symptoms in limbs （especially lower limbs）， chest， bladder， fleshy exterior， and stomach， with the main manifestations of deficiency-cold， Qi deficiency， fluid retention， and blood stasis. The clustering analysis classified the patients into 11 categories， which reflected that kidney Yang deficiency syndrome mainly presented the symptoms of Qi deficiency， blood stasis， and fluid retention， with fleshy exterior， limbs， spleen， stomach， ears， mind， and bladder involved. The results of clustering analysis and factor analysis were consistent， both of which indicated that the patients were weak with deficiency-cold， accompanied by fluid retention and blood stasis. Frequency analysis also showed that common symptoms mainly included Qi deficiency， fluid retention， cold-dampness， and blood stasis. Compared with the non-kidney Yang deficiency group， the kidney Yang deficiency group showed a large proportion of patients in stage 3-5 CKD， elevated urea nitrogen （P<0.05）， decreased glomerular filtration rate， hemoglobin， and red blood cell count （P<0.05）， and increased qualitative grade of urine protein. In addition， the results of regression analysis showed that female， little or no exercise， and diet preference were the risk factors for kidney Yang deficiency syndrome in CKD （P<0.05）. ConclusionThe disease location and manifestations have correspondence in the CKD patients with kidney Yang deficiency syndrome. The TCM symptoms are correlated with clinical indicators. Hemoglobin， red blood cell count， glomerular filtration rate， urea nitrogen， and urine protein can reflect the connotation of kidney Yang deficiency syndrome in CKD to a certain extent. Additionally， related risk factors in life can affect the occurrence of kidney Yang deficiency syndrome in CKD.

Significance of affected side sensorimotor area in recovery of upper limb motor function after subcortical cerebral infarction / 中华神经科杂志

Objective:To explore the value and significance of sensorimotor cortex (SMC) in the recovery of upper limb motor function after cerebral infarction in the striatum with blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI).Methods:A total of 17 patients with primary onset of striatal intracapsular infarction (SCI) with unilateral severe upper limb paralysis, who were strictly screened from the Department of Neurology, Affiliated Hospital of Yangzhou University from June 2015 to December 2017, were selected as research subjects, and 15 healthy volunteers were selected as controls. BOLD-fMRI under the passive finger extension (FE) task on the hemiplegic side was performed within one week, one month and three months after the onset of the disease. The activation of SMC was observed by SPM8 software. The activation of corresponding brain activation areas in BOLD-fMRI was observed by Xjview software and compared with the standard brain activation areas dynamically. The upper limb section of the Fugl-Meyer Scale (FM-UL) was used to track the motor function of the upper limb. The upper limb motor function of the selected patients was evaluated before functional magnetic resonance imaging (fMRI) scanning, at one month and three months after onset of the disease.Results:In the controls, fMRI showed that the main brain activation areas were located in the contralateral SMC and bilateral supplementary motor area. According to the activation time course of the affected side SMC and the comparison results with the standard brain activation area, the study patients were divided into three groups: group 1 (six patients), in which the activation intensity of SMC was stronger than that of standard brain activation area in the early stage of onset; group 2 (five patients), in which the activation intensity of SMC in the affected side was stronger than that in the standard brain activation area at one month after onset; group 3 (six patients), in which the activation intensity of SMC in the affected side increased gradually in three months, but still did not exceed the standard brain activation area. The activated voxel values of the affected side SMC in group 1 patients at the first time, one month and three months were 3 570.2±1 125.9, 1 205.8±328.2 and 1 121.5±407.5, respectively, the difference within the group being statistically significant ( F=12.8, P=0.001); the activated voxel values of the affected SMC in group 2 patients were 556.2±171.7, 648.6±177.3 and 993.2±182.9, respectively, and the differences within the group were statistically significant ( F=6.5, P=0.018); the activated SMC values of the affected SMC in group 3 patients were 520.0±375.9, 573.5±375.0 and 680.9±359.8, respectively, and there was no statistically significant difference within the group ( P>0.05). The three times FM-UL scores corresponding to group 1 patients were (10.0±3.3) points, (52.3±4.6) points and (63.7±2.9) points; the three times FM-UL scores corresponding to group 2 patients were (10.6±5.7) points, (36.6±2.4) points and (59.2±3.1) points; and the three times FM-UL scores corresponding to group 3 patients were (9.2±4.0) points, (12.5±3.0) points and (13.3±5.0) points; FM-UL scores in group 1 and group 2 patients showed statistically significant differences within the groups ( F=348.4, 183.6; P<0.001), whereas that in group 3 patients showed no statistically significant difference within the group ( P>0.05). There was no statistically significant difference in the initial FM-UL score among the groups ( P>0.05), while the differences among the groups at one month and three months were statistically significant ( F=191.7,304.5; P<0.001). Conclusions:The survival of SMC on the affected side after cerebral infarction is a prerequisite for the rehabilitation of limb motor function. Its early activation cannot predict the clinical prognosis, but the dynamic enhancement of SMC activation on the affected side is related to the rehabilitation speed of the affected limb.

Correlation between fluid attenuation inversion recovery vascular hyperintensities-diffusion weighted imaging mismatch and the outcomes of endovascular mechanical thrombectomy in patients with middle cerebral artery M1 segment occlusive stroke / 国际脑血管病杂志

Objective:To investigate the correlation between fluid attenuated inversion recovery vascular hyperintensities (FVH) -diffusion weighted imaging (DWI) mismatch and the outcomes after endovascular mechanical thrombectomy (EMT) in patients with acute middle cerebral artery M1 segment occlusive stroke.Methods:Patients with middle cerebral artery M1 segment occlusive stroke who received EMT treatment and whose FLAIR images showed FVH in the Affiliated Hospital of Yangzhou University from January 2016 to June 2020 were enrolled retrospectively. The demographics and basic clinical information of the patients were collected. The modified Rankin Scale was used to evaluate the outcomes at 3 months after the onset of symptoms. 0-2 was defined as a good outcome, and >2 was defined as a poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 77 patients were enrolled in the study. Their age was 67.16±9.63 years, 51 were males (66.23%). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 14.16±7.49. Forty patients (51.95%) had a good outcome, and 37 (48.05%) had a poor outcome. Univariate analysis showed that the proportion of patients with FVH-DWI mismatch in the good outcome group was significantly higher than that in the poor outcome group (60.00% vs. 29.73%; χ2=7.103, P=0.008), and baseline NIHSS score (11.60±4.44 vs. 16.92±9.05; t=-3.312, P=0.001) and the proportion of patients with hypertension (65.00% vs. 86.49%; χ2=4.774, P=0.029) were significantly lower than those in the poor outcome group. Multivariate logistic regression analysis showed that FVH-DWI mismatch was independently associated with the good outcomes (odds ratio [ OR] 0.345, 95% confidence interval [ CI] 0.121-0.984; P=0.047), baseline NIHSS score was independently associated with the poor outcomes ( OR 1.133, 95% CI 1.036-1.239; P=0.006). Conclusion:FVH-DWI mismatch was independently associated with the good outcomes after EMT treatment in patients with acute middle cerebral artery M1 segment occlusive stroke.

Research progress on the mechanism of aggressive behavior induced by antiepileptic drugs / 中国医师杂志

Antiepileptic drugs (AEDs) are the main treatments of epilepsy, but their use is usually limited by adverse reactions, among them psychiatric and behavioral ones including aggressive behavior. Levetiracetam , perampanel, and topiramate , which have diverse mechanisms of action, have been associated with aggressive behavior. 5-HT and γ-aminobutyric acid (GABA), especially glutamate [via α-amino-3-hydroxy-5-methyl-4-isoxazole-propionate receptor (AMPA) receptor] seem to play key roles. Other mechanisms involve hormones, epigenetics and alternative psychosis. Neurological and/or mental health disorders tend to increase aggressive behavior sensitivity. The adverse reactions caused by AEDs are getting more and more attention. Clinicians may identify and manage this side effect as early as possible, if the risk factors and underlying mechanisms of aggressive behavior induced by antiepileptic we find. This article will explain the possible mechanisms.

Sleep disorders after acute ischemic stroke / 国际脑血管病杂志

Ischemic stroke is the most common type of cerebrovascular disease, which has the characteristics of high morbidity, high disability, and high mortality. Sleep disorder is a common complication after ischemic stroke, which can increase the risk of stroke recurrence and seriously affect the outcome of patients. This article reviews the classification and mechanism of post-stroke sleep disorders, the impact on the outcome of patients, the changes in sleep structure of patients with stroke, and the diagnosis and treatment of post-stroke sleep disorders, in order to improve clinicians' understanding of post-stroke sleep disorders.

Distribution and morphological characteristics of symptomatic atherosclerotic plaques in the middle cerebral artery using high?resolution magnetic resonance imaging / 中华神经科杂志

Objective To observe distribution and morphological characteristics of symptomatic atherosclerotic plaques in the middle cerebral artery (MCA) using high?resolution magnetic resonance imaging (HR?MRI), and to investigate HR?MRI characteristics of atherosclerotic plaques in the MCA in patients with acute cerebral infarction. Methods A total of 57 symptomatic patients with MCA atherosclerotic plaques recruited in the Affiliated Hospital of Yangzhou University from January 2014 to January 2016 were imaged with diffusion weighted imaging (DWI), three dimensional time of flight magnetic resonance angiography (3D TOF?MRA) and HR?MRI scanning for plaque on a 3.0 T MRI scanner. According to the results of DWI examination, the 57 patients were divided into transient ischemic attack (TIA) group (27 cases) and acute cerebral infarction group (30 cases). The distribution of the narrowest lumen plaque was evaluated by cross?section division into four equal arcs (superior, inferior, ventral, dorsal arcs). For quantitative analysis, lumen area (LAMLN), vessel area (VAMLN) at maximal lumen narrow (MLN) and LAreference, VAreference were measured, then wall area (WA), plaque area (PA), percentage of plaque burden, rate of lumen stenosis and remodeling index (RI) were calculated. The data of each group were compared and analyzed. Results The location and morphological analysis of the 57 patients with symptomatic MCA atherosclerotic plaques revealed that plaques were located in the ventral wall in 19 cases (33.3%), the upper wall in 15 cases (26.3%), the dorsal wall in 10 cases (17.5%), and the lower wall in 13 cases (22.8%). For the location variations in ventral wall, upper wall, dorsal wall and lower wall, the TIA group was shown as six cases (22.2%), five cases (18.5%), seven cases (25.9%) and nine cases (33.3%), and the acute cerebral infarction group was shown as 13 cases (43.3%), 10 cases (33.3%), three cases (10.0%) and four cases (13.3%), respectively. There was no statistically significant difference in the distribution of each side wall between the two groups (P>0.05). VAreference, LAreference, VAMLN and RI of the TIA group and the acute cerebral infarction group were (19.89 ± 1.34) mm2, (15.19 ± 2.04) mm2, (20.78 ± 1.78) mm2, 1.09 ± 0.11 and (19.70 ± 1.34) mm2, (14.60 ± 2.33) mm2, (21.53 ± 2.34) mm2, 1.10 ± 0.11, respectively. There was no statistically significant difference between the two groups (P>0.05). The remodeling patterns of both groups were mainly positive remodeling, with a total of 44 cases (77.2%). In the TIA group and the acute cerebral infarction group, the WAMLN, PA, stenosis rate and plaque load percentages were (8.85±1.92) mm2, (4.00±3.00) mm2, 20.92%± 9.18%, 19.05% ± 14.93% and (11.10 ± 1.88) mm2, (6.00 ± 2.25) mm2, 28.56% ± 8.67%, 27.30% ± 7.69%, respectively. The differences between the two groups were statistically significant (t=-4.466, t=-2.865, t=-3.231, t=-2.580, P<0.01). There were eight patients (29.6%) with unsmooth plaque surface in the TIA group and 19 patients (63.3%) in the acute cerebral infarction group. The differences between the two groups were statistically significant (χ2=6.475, P<0.05). LAMLN in the TIA group and the acute cerebral infarction group was (11.93±1.59) mm2 and (10.43±2.08) mm2 respectively, and the difference between the two groups was statistically significant (t=3.033, P<0.01). Conclusions Symptomatic atherosclerotic plaques in MCA in the acute cerebral infarction group have higher plaque load, thicker vascular wall at the maximum stenosis and more unsmooth plaque surface. This indicates the characteristics of high?risk plaques to a certain extent.

Risk factors of hemorrhage after thrombolysis for mild cerebral infarction and the curative effect of low-dose alteplase / 中国医师杂志

Objective To analyze the risk factors of hemorrhage after thrombolysis for mild cerebral infarction and the curative effect of low-dose alteplase.Methods 375 patients with mild cerebral infarction whose onset time was less than 4.5 hours from January 2013 to May 2017 in our hospital were selected as the research objects.Those undergoing low-dose alteplase thrombolysis were included in the thrombolysis group (n =195) while those without thrombolysis were included in the non-thrombolysis group (n =180).The therapeutic effects were analyzed.Patients with intracerebral hemorrhage in the thrombolysis group at 14 days after thrombolysis were included in the observation group while those without hemorrhage were included in the control group.Related data were compared between the two groups.The single factors and independent risk factors of hemorrhage after thrombolysis in patients with mild cerebral infarction were analyzed.Results National Institute of Health Stroke Scale (NIHSS) scores of the thrombolysis group at 1 week,1 month and 3 months after treatment were significantly lower than those of the non-thrombolysis group (P ＜0.05).Serum neuron specific enolase (NSE) and C-reactive protein (CRP) levels in the thrombolysis group were lower than those in the non-thrombolysis group after treatment (P ＜ 0.05).The prognosis of the thrombolysis group was better than that of the non-thrombolysis group after treatment (P ＜ 0.05).In this study,30 patients undergoing thrombolysis had intracerebral hemorrhage within 14 days after thrombolysis,and the incidence of intracranial hemorrhage was 15.38％ (30/195).Univariate and multivariate logistic regression analysis showed that age,history of heart failure,door to needle time (DNT),systolic blood pressure (SBP) in 12 hours after thrombolysis and leukoaraiosis change were risk factors for hemorrhage in patients with mild cerebral infarction after thrombolysis (P ＜ 0.05).Conclusions Using low-dose alteplase for treating patients with mild cerebral infarction can achieve good thrombolytic effects.Age,history of heart failure,DNT,SBP in 12 hours after thrombolysis and leukoaraiosis change are influencing factors of intracranial hemorrhage,which should be paid attention to.

P-wave dispersion parameters predict paroxysmal atrial fibrillation in patients with embolic stroke of undetermined source / 国际脑血管病杂志

Objective To investigate the possibility of P-wave dispersion parameters of 12-lead ECG in predicting paroxysmal atrial fibrillation (PAF) in patients with embolic stroke of undetermined source (ESUS).Methods Patients with ESUS admitted to the Department of Neurology,the Affiliated Hospital of Yangzhou University from January 2017 to December 2018 were enrolled.According to the findings of 24 h dynamic ECG monitoring,they were divided into PAF group and non-PAF group.The maximum P-wave duration (Pmax),minimum P-wave duration (Pmm) and P-wave dispersion (Pd) in the conventional 12-1ead ECG were documented.Multivariate logistic regression analysis was used to determine the independent correlation between different P-wave dispersion parameters and PAF in patients with ESUS.Results A total of 87 patients with ESUS were enrolled,including 40 females and 47 males,with an average age of 68.53 ± 10.68 years.PAF was detected in 17 patients (19.54％).There were significant differences in age,baseline NIHSS score,Pmax,Pd,and left atrial diameter (LAD) between the PAF group and the non-PAF group (all P ＜0.05).Multivariate logistic regression analysis showed that Pd Was the only independent predictor of PAF in patients with ESUS (odds ratio,1.279,95％ confidence interval 1.048-1.561,P =0.015).Conclusion Pd is an independent predictor of PAF in patients with ESUS.

Investigation on the incidence of sexual dysfunction and related factors in Han women with epilepsy / 中华神经科杂志

Objective To investigate the incidence and related factors of sexual dysfunction in Chinese Han women with epilepsy (WWE).Methods A total of 112 cases of Han married WWE were continuously recruited from January 2015 to December 2017 in the Affiliated Hospital of Yangzhou University,and 120 matched non-epileptic healthy Han married women served as controls.The 112 WWE were classified as focal or comprehensive onset epilepsy and were treated with antiepileptic drugs (AEDs) for one year or more.Data collection was performed with a form inquiring about the participants' demographic parameters,including age,duration of marriage,education level,employment,monthly family income per capita,history of infertility and irregular menses.Details of epilepsy in WWE were investigated,including age of onset,duration of illness,seizure frequency,medication adherence.All participants were submitted to relevant scales and questionnaires (Female Sexual Function Index,Zung Self-Rating Anxiety Scale and Zung Self-Rating Depression Scale).In addition,WWE were evaluated by the 8-Item Morisky Medication Adherence Scale and the National Hospital Seizure Severity Scale.Chi-square test,t test and binary Logistic regression were used for statistical analysis.Results A high rate (70.5％,79/112) of sexual dysfunction was detected in WWE,whereas 24.2％ (29/120) in controls (x2=50.061,P＜0.01).Sexual dysfunction affected all dimensions:desire (85.7％,96/112),arousal (56.3％,63/112),lubrication (47.3％,53/112),orgasm (66.1％,74/112),satisfaction (58.9％,66/112) and pain (41.1％,46/112).Elevated rates of anxiety (40.2％,45/112),depression (33.0％,37/112) and poor medication adherence (31.3％,35/112) were also found in WWE.Binary Logistic regression showed that family economic status (monthly family income per capita ＜1 500 Yuan (OR=8.852,95％CI:1.469-53.346,P=0.017),monthly family income per capita 1 500-2 500 Yuan (OR=6.438,95％CI:1.439-28.796,P=0.015)),anxiety (OR=1.202,95％CI:1.050-1.375,P=0.008) and medication adherence (OR=0.371,95％CI:0.155-0.890,P=0.026) were associated with sexual dysfunction.Conclusions The associated factors of sexual dysfunction in Chinese Han WWE are multifactorial.WWE have higher levels of anxiety,poor family economic status and poor medication adherence.Medical professionals should not only better control seizures,but also evaluate and improve patients' sexual function,so as to improve the quality of life of WWE.

Risk factors and early prognosis of patients with acute cerebral infarction complicated with intracranial unruptured aneurysms / 中华神经科杂志

Objective To investigate the risk factors for unruptured intracranial aneurysms (UIA) in patients with acute cerebral infarction and whether the UIA affect early prognosis in patients with acute cerebral infarction.Methods Inpatients with acute cerebral infarction diagnosed at the Affiliated Hospital of Yangzhou University from January 2009 to August 2017 were retrospectively collected.Diagnosis of acute cerebral infarction and UIA was established by emergency magnetic resonance imaging and three dimensional time of flight magnetic resonance angiography screening.All patients with acute cerebral infarction were divided into the group with no intracranial aneurysm (A) and the group with UIA (B).Baseline materials such as demographics and cerebrovascular risk factors were used to analyze the comorbidity and risk factors of acute cerebral infarction and UIA.According to the modified Rankin scale (mRS) scores after 90 days,the patients were divided into a good prognosis group (mRS score ≤2) and a poor prognosis group (mRS score ≥3).The influence of the location,size,number of UIA and different treatments in the acute phase on the early prognosis of the two comorbidities was analyzed,and the relevant risk factors affecting prognosis were screened out.Results Of the 3 917 patients with acute cerebral infarction,3 641 patients met the inclusion criteria,and 237 patients (6.51％) had UIA.The proportion of age,women,smoking and hypertension in group B was significantly higher than that in group A.Multivariate regression analysis showed that women (odds ratio (OR)=1.691,95％ confidence interval (CI) 1.249-2.290,P=0.001),age (OR=1.023,95％ CI 1.010-1.036,P=0.000),smoking (OR=1.942,95％ CI 1.413-2.670,P=0.000),hypertension (OR=1.539,95％ CI 1.025-2.309,P=0.037) were significandy correlated with acute cerebral infarction complicated with UIA.There were 2 346 cases (64.43％) in the good prognosis group and 1 295 cases (35.57％) in the poor prognosis group after 90 days of onset.No statistically significant difference was found in the presence of UIA between the two groups (x2=0.002,P=0.967).There was no significant correlation between location,size and number of treatments,treatment patterns,the Trial of Org 10172 in Acute Stroke Treatment classification and patient outcome.Further Logistic regression analysis showed age (OR=1.009,95％CI 1.003-1.016,P=0.003),diabetes (OR=1.235,95％ CI 1.076-1.418,P=0.003),history of previous stroke (OR=1.544,95％ CI 1.324-1.801,P=0.000) and National Institutes of Healthy Stroke Scale (NIHSS) score at admission (OR=1.037,95％ CI 1.020-1.054,P=0.000) were significantly associated with poor outcomes in patients with acute cerebral infarction.Conclusions Female,age,smoking and hypertension were found to be risk factors for comorbidity of acute cerebral infarction and UIA.The location,size,and different treatments of UIA were not found to have a significant effect on early prognosis in patients with acute cerebral infarction;age,diabetes,previous stroke history,and baseline NIHSS score were high risk factors affecting early prognosis in patients with acute cerebral infarction with or without UIA.

Mild stroke caused by large vessel occlusion: clinical features and reperfusion treatment / 国际脑血管病杂志

The incidence of mild stroke is high.If accompanied by large vessel occlusion,the risk of poor outcome is significantly increased,and even death,so early reperfusion therapy is needed.This article reviews the clinical features and treatment of mild stroke caused by large vessel occlusion.

Correlation between serum miR-320b and carotid atherosclerosis in patients with acute ischemic stroke / 国际脑血管病杂志

Objective To investigate the correlation between serum miR-320b and carotid atherosclerosis in patients with acute ischemic stroke.Methods From January 2017 to December 2017,patients with acute ischemic stroke visited the Department of Neurology,the Affiliated Hospital of Yangzhou University were enrolled.According to the findings of carotid artery ultrasonography,they were divided into plaque group and plaque-free group.The baseline clinical data such as demographic data,vascular risk factors,and blood biochemical indicators were collected.Reverse transcription quantitative polymerase chain reaction was used to detect the expression level of serum miR-320b.Multivariatelogistic regression analysis was used to determine the independent risk factors for carotid atherosclerosis.Results A total of 135 patients with acute ischemic stroke were enrolled in this study,including 58 females and 77 males,aged 58.4 ± 10.6 years.There were 85 patients in the plaque group and 50 in the plaque-free group.The total cholesterol (t =5.523,P =0.023) and low-density lipoprotein cholesterol (t =4.415,P =0.044) in the plaque group were significantly higher than those in the plaque-free group,while high-density lipoprotein cholesterol (t =5.849,P=0.017) and serum miR-320b (t =4.331,P=0.039) were significantly lower than those in the plaque-free group.Multivariate logistic regression analysis showed that referring to the highest quartile group,the low serum miR-320b level might be an independent risk factor for carotid atherosclerosis (the first quartile group:odds ratio 2.701,95％ confidence interval 1.154-6.321,P =0.022;the second quartile group:odds ratio 2.521,95％ confidence interval 1.249-5.091,P =0.010;and the third quartile group:odds ratio 1.849,95％ confidence interval 1.041-3.283,P=0.036).Conclusion The low serum miR-320b level might be an independent risk factor for carotid atherosclerosis in patients with acute ischemic stroke.

Correlation between three-dimensional high-resolution magnetic resonance imaging enhancement characteristics of plaque and time of symptom onset of stroke in patients with intracranial atherosclerotic stenosis / 中华神经科杂志

Objective@#To assess the enhancement characteristics of plaques in patients with intracranial atherosclerotic stenosis using three-dimensional high-resolution magnetic resonance imaging (3D HR MRI), and to analyze the correlation between the enhancement characteristics of plaques and the time from onset of stroke symptoms to MRI examination.@*Methods@#The enhancement characteristics of plaques were retrospectively analyzed in 61 patients with cerebral infarction who were scanned in MRI room of the Affiliated Hospital of Yangzhou University from January 2014 to January 2016. According to the elapsed time between symptom onset and MR examination, 61 patients were classified into early stage group (<4 weeks, n=26), middle stage group (4-12 weeks, n=20) and late stage group (>12 weeks, n=15). All cases underwent three-dimensional sampling perfection with application optimized contrast using different angle evolutions (3D-SPACE) T1WI and enhanced 3D-SPACE T1WI sequence scans, as well as routine head MRI examinations. The signal intensities of plaques before and after enhancement scanning were compared on the 3D-SPACE T1WI sequence. The degrees of plaque enhancement were qualitatively analyzed, and the enhancement rates of plaques were quantitatively calculated. The correlation between the enhancement characteristics of plaques and time of symptom onset of stroke was analyzed.@*Results@#Sixty-one intracranial atherosclerotic plaques on the 3D HR MRI showed eccentric thickening or annular thickening of the vessel wall, and slightly higher signals on the T1WI. They showed different degrees of enhancement or no enhancement after enhancement scans. The characteristics of plaque enhancement in 61 patients with cerebral infarction were analyzed. The results showed that 26 plaques in the early stage group were obviously enhanced for 21 cases (80.8%), mildly enhanced for 4 cases (15.4%), no enhancement for 1 case (3.8%), and the enhancement rate was 80.49%±18.64%. Twenty plaques in the middle stage group were obviously enhanced for 2 cases (10.0%), mildly enhanced for 14 cases (70.0%), no enhancement for 4 cases (20.0%), and the enhancement rate was 52.09%±18.17%. Fifteen plaques in the late stage group were mildly enhanced for 2 cases (2/15), no enhancement for 13 cases (13/15), and the enhancement rate was 12.16%±10.44%. There were statistically significant differences in the degrees of plaque enhancement and plaque enhancement rates among the three groups (χ2=22.834, P<0.01; F=78.403, P<0.01). Further analysis showed that there was a statistically significant difference in the degree of enhancement and enhancement rate of plaques between the early stage group and the middle stage group (χ2=-4.177, P<0.01; t=5.179, P<0.01), and there was a statistically significant difference between the middle stage group and the late stage group (χ2=-2.484, P<0.05; t′=8.189, P<0.01), and the difference between the early stage group and the late stage group was also statistically significant (χ2=-3.796, P<0.01; t′=15.044, P<0.01). There was a significant negative correlation between the time from onset of stroke symptoms to MRI examination and the enhancement rate of plaques (r=-0.903, P<0.01).@*Conclusions@#Enhanced HR MRI scanning can clearly show the enhancement of intracranial atherosclerotic plaques. With the prolongation of the onset time interval, the enhancement of intracranial atherosclerotic plaques gradually weakens, which can assess the vulnerability of plaques and has important guiding significance for secondary prevention of ischemic stroke.

Distribution and morphological characteristics of symptomatic atherosclerotic plaques in the middle cerebral artery using high-resolution magnetic resonance imaging / 中华神经科杂志

Objective@#To observe distribution and morphological characteristics of symptomatic atherosclerotic plaques in the middle cerebral artery (MCA) using high-resolution magnetic resonance imaging (HR-MRI), and to investigate HR-MRI characteristics of atherosclerotic plaques in the MCA in patients with acute cerebral infarction.@*Methods@#A total of 57 symptomatic patients with MCA atherosclerotic plaques recruited in the Affiliated Hospital of Yangzhou University from January 2014 to January 2016 were imaged with diffusion weighted imaging (DWI), three dimensional time of flight magnetic resonance angiography (3D TOF-MRA) and HR-MRI scanning for plaque on a 3.0 T MRI scanner. According to the results of DWI examination, the 57 patients were divided into transient ischemic attack (TIA) group (27 cases) and acute cerebral infarction group (30 cases). The distribution of the narrowest lumen plaque was evaluated by cross-section division into four equal arcs (superior, inferior, ventral, dorsal arcs). For quantitative analysis, lumen area (LAMLN), vessel area (VAMLN) at maximal lumen narrow (MLN) and LAreference, VAreference were measured, then wall area (WA), plaque area (PA), percentage of plaque burden, rate of lumen stenosis and remodeling index (RI) were calculated. The data of each group were compared and analyzed.@*Results@#The location and morphological analysis of the 57 patients with symptomatic MCA atherosclerotic plaques revealed that plaques were located in the ventral wall in 19 cases (33.3%), the upper wall in 15 cases (26.3%), the dorsal wall in 10 cases (17.5%), and the lower wall in 13 cases (22.8%). For the location variations in ventral wall, upper wall, dorsal wall and lower wall, the TIA group was shown as six cases (22.2%), five cases (18.5%), seven cases (25.9%) and nine cases (33.3%), and the acute cerebral infarction group was shown as 13 cases (43.3%), 10 cases (33.3%), three cases (10.0%) and four cases (13.3%), respectively. There was no statistically significant difference in the distribution of each side wall between the two groups (P>0.05). VAreference, LAreference, VAMLN and RI of the TIA group and the acute cerebral infarction group were (19.89±1.34) mm2, (15.19±2.04) mm2, (20.78±1.78) mm2, 1.09±0.11 and (19.70±1.34) mm2, (14.60±2.33) mm2, (21.53±2.34) mm2, 1.10±0.11, respectively. There was no statistically significant difference between the two groups (P>0.05). The remodeling patterns of both groups were mainly positive remodeling, with a total of 44 cases (77.2%). In the TIA group and the acute cerebral infarction group, the WAMLN, PA, stenosis rate and plaque load percentages were (8.85±1.92) mm2, (4.00±3.00) mm2, 20.92%±9.18%, 19.05%±14.93% and (11.10±1.88) mm2, (6.00±2.25) mm2, 28.56%±8.67%, 27.30%±7.69%, respectively. The differences between the two groups were statistically significant (t=-4.466, t=-2.865, t=-3.231, t=-2.580, P<0.01). There were eight patients (29.6%) with unsmooth plaque surface in the TIA group and 19 patients (63.3%) in the acute cerebral infarction group. The differences between the two groups were statistically significant (χ2=6.475, P<0.05). LAMLN in the TIA group and the acute cerebral infarction group was (11.93±1.59) mm2 and (10.43±2.08) mm2 respectively, and the difference between the two groups was statistically significant (t=3.033, P<0.01).@*Conclusions@#Symptomatic atherosclerotic plaques in MCA in the acute cerebral infarction group have higher plaque load, thicker vascular wall at the maximum stenosis and more unsmooth plaque surface. This indicates the characteristics of high-risk plaques to a certain extent.

The correlation of sexual dysfunction and estrogen receptor gene polymorphism in Chinese Han women with epilepsy / 中华行为医学与脑科学杂志

Objective@#To investigate the correlation between sexual dysfunction(SD)and estrogen receptor (ER) gene polymorphism in Chinese Han women with epilepsy (WWE).@*Methods@#A total of 112 married Chinese Han women with epilepsy were collected from outpatients and inpatients of the Affiliated Hospital of Yangzhou University, and 120 matched healthy women were taken as the control group.WWE were treated with antiepileptic drugs (AEDs) for one year or more.The Chinese version of female sexual function index (FSFI) was used to investigate the sexual function of the subjects.The chemiluminescence method was used to detect the sex hormones levels such as prolactin(PRL), follicle-stimulating hormone(FSH), luteinizing hormone(LH), estradiol(E2), progesterone(P) and testosterone(T). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the ER gene polymorphism.Chi-square test, t-test and binary logistic regression were used for statistical analysis.The differences of the sexual function, sex hormone, ER genotype, and allele frequency were compared between the two groups.And the correlation between SD and ER gene polymorphism was analyzed.@*Results@#(1) The proportion of SD in Chinese Han WWE was 70.5%(79/112), while that was 24.2%(29/120) in the control group.The serum prolactin (PRL) level in the WWE group was significantly higher than that in the control group (t=2.072, P=0.039). (2) The allele frequencies of ER PvuII C and AluI A in the WWE group were significantly higher than those in the control group (P=0.001; P=0.001). (3) Binary logistic regression analysis showed that PvuII CC genotype and serum testosterone level were independently correlated with SD (OR=6.074, 95%CI: 1.257-29.352, P=0.025; OR=0.412, 95%CI: 0.201-0.842, P=0.015).@*Conclusion@#ERα PvuII polymorphism may be related to the susceptibility of SD in Chinese Han WWE, and PvuII CC genotype may be the risk genotype of SD in WWE.

The correlation of sexual dysfunction and estrogen receptor gene polymorphism in Chinese Han women with epilepsy / 中华行为医学与脑科学杂志

Objective To investigate the correlation between sexual dysfunction( SD) and estrogen receptor (ER) gene polymorphism in Chinese Han women with epilepsy (WWE). Methods A total of 112 married Chinese Han women with epilepsy were collected from outpatients and inpatients of the Affiliated Hospital of Yangzhou University,and 120 matched healthy women were taken as the control group. WWE were treated with antiepileptic drugs ( AEDs) for one year or more. The Chinese version of female sexual function index ( FSFI) was used to investigate the sexual function of the subjects. The chemiluminescence method was used to detect the sex hormones levels such as prolactin ( PRL),follicle-stimulating hormone (FSH),luteinizing hormone(LH),estradiol(E2),progesterone(P) and testosterone(T). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the ER gene poly-morphism. Chi-square test,t-test and binary logistic regression were used for statistical analysis. The differ-ences of the sexual function,sex hormone,ER genotype,and allele frequency were compared between the two groups. And the correlation between SD and ER gene polymorphism was analyzed. Results ( 1) The pro-portion of SD in Chinese Han WWE was 70. 5%(79/112),while that was 24. 2%(29/120) in the control group. The serum prolactin (PRL) level in the WWE group was significantly higher than that in the control group (t=2. 072,P=0. 039). (2) The allele frequencies of ER PvuII C and AluI A in the WWE group were significantly higher than those in the control group (P=0. 001;P=0. 001). (3) Binary logistic regression a-nalysis showed that PvuII CC genotype and serum testosterone level were independently correlated with SD (OR= 6. 074, 95% CI: 1. 257-29. 352, P= 0. 025; OR= 0. 412, 95% CI: 0. 201-0. 842, P= 0. 015 ). Conclusion ERα PvuII polymorphism may be related to the susceptibility of SD in Chinese Han WWE,and PvuII CC genotype may be the risk genotype of SD in WWE.

Treatment of MRA-DWI mismatched patients with mild ischemic stroke caused by middle cerebral artery M1 segment occlusion: comparison of endovascular treatment and intravenous thrombolytic therapy / 国际脑血管病杂志

Objective To investigate the effect of different treatment regimens guided by magnetic resonance angiography (MRA) and diffusion weighted imaging (DWI) mismatch on the outcomes of patients with mild ischemic stroke caused by acute middle cerebral artery (MCA) M1 segment occlusion. Methods From January 2013 to February 2018, the clinical data of patients with mild ischemic stroke caused by acute MCA M1 segment occlusion and admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University were analyzed retrospectively. Mild stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤5, and the MRA-DWI mismatch was defined as MCA M1 segment occlusion confirmed by MRA and the DWI-Alberta Stroke Program Early Computed Tomography Score ≥6. According to the clinical decision, they were divided into endovascular treatment group and intravenous thrombolytic therapy group. The primary outcome measure was the modified Rankin Scale score at 90 days after onset, ≤2 was defined as good outcome. The secondary outcome measure was the incidence of symptomatic intracranial hemorrhage (sICH) within 7 days after treatment and the mortality rate at 90 d. Multivariate logistic regression analysis was used to determine the independent effects of different treatment regimens on outcomes. Results A total of 38 patients were enrolled, 19 (50. 00％) in the intravenous thrombolytic therapy group, and 19 in the endovascular treatment group (50. 00％, including 5 patients with intratracheal thrombectomy after intravenous thrombolysis); 27 patients had good outcomes (71. 05％) and 11 had poor outcomes (28. 95％). Except for total cholesterol level, there were no significant differences in demography, vascular risk factors, and all baseline clinical data between the endovascular treatment group and the intravenous thrombolytic therapy group. The rate of good outcome in the endovascular treatment group was significantly higher than that in the intravenous thrombolytic therapy group (89. 47％ vs. 2. 63％; P = 0. 029), and there was no significant difference between the incidence of sICH within 7 days (15. 79％ vs. 5. 26％; P = 0. 604) and 90-day mortality (0％ vs. 10. 53％; P = 0. 486). The proportion of patients who underwent endovascular treatment in the good outcome group was significantly higher than that in the poor outcome group (62. 96％ vs. 18. 18％; P = 0. 029). Multivariate logistic regression analysis showed that endovascular treatment was an independent predictor of good outcome (odds ratio 0. 103, 95％ confidence interval 0. 015-0. 714; P = 0. 021). Conclusion Endovascular treatment is an independent predictor of good outcome in patients with mild ischemic stroke caused by acute MCA M1 segment occlusion.