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Objective To investigate the effects of enteral nutrition via the nasojejunal and nasogastric feeding on stroke-associated pneumonia (SAP) and other complications in patients with severe acute stroke.Methods A total of 60 patients with severe acute stroke who needed tube feeding were randomized to either a nasojejunal tube group or a nasaogastric tube group for enteral nutrition support.The occurrence of SAP,diarrhea,vomiting,and gastrointestinal bleeding within 2 weeks were observed.The nutrition indices (total protein,prealbumin,and hemoglobin) before and at day 7 and 14 after the tube placement were documented and compared.Results There were 30 patients in the nasojejunal tube group and the nasaogastric rube group,respectively.There were no significant difference in demographic and baseline clinical data between the 2 groups.The incidence of SAP (43.3％ vs.70.0％;x2 =4.340,P=0.037),vomiting (13.3％ vs.43.3％;x2 =6.648,P =0.010),and hyponatremia (6.7％ vs.40.0％;x2 =4.022,P =0.045) in the nasojejunal rube group were significant lower than those in the nasogastric rube group,however,there was no significant differences in the incidences of diarrhea and gastrointestinal bleeding.Compared with before indwelling tube,there were no significant difference in the concentrations of total plasma protein and prealbumin at day 14 after indwelling tube in the nasojejunal tube group,but the concentration of hemoglobin were decreased significantly (P =0.001);compared with before indwelling tube,the concentrations of the total plasma protein (P =0.001),prealbumin (P =0.036),and hemoglobin (P =0.001) at day 14 after indwelling tube in the nasogastric rube group were significantly decreased.Conclusions Nasojejunal nutrition may effectively prevent SAP,volmiting,and hyponatremia in patients with severe acute stroke,and contributes to maintain the nutritional status.
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Objective To investigate the correlation between carotid intraplaque neovascularization and acute ischemic cerebrovascular disease. Methods The patients examined with contrast-enhanced ultrasound were enroled and divided into either a symptomatic group or an asymptomatic group according to their cerebral ischemic symptoms. The patients were also divided into a low-echo group, an equal-echo group, and an heterogeneous echo group according to the plaque echo characteristics on conventional ultrasound. The carotid intraplaque neovascularization was evaluated with contrast-enhanced ultrasound. Multivariate logistic regression analysis was used to identify the correlation between carotid intraplaque neovascularization and acute ischemic cerebrovascular disease. Results A total of 73 patients with acute ischemic cerebrovascular disease were enroled, 32 patients in the symptoms group (19 ischemic stroke, 13 transient ischemic attack), 41 patients in the asymptomatic group. Plaque echo characteristics: low-echo 15, equal-echo 41, and heterogeneous echo 17. The proportions of the patients with plaque enhancement (84. 4% vs. 61. 0% ; χ2 = 4. 802, P = 0. 028) and enhanced intensity (21. 78 ± 8. 50 dB vs. 15. 93 ± 8. 82 dB; t = 2. 440, P = 0. 018) in the symptomatic group were significantly higher than those in the asymptomatic group. The proportions of the patients with enhanced plaque in the low-echo, equal-echo and heterogeneous echo group were 93. 3% , 58. 5% , and 82. 4% , respectively (χ2 = 7. 826, P = 0. 020 ). The low-echo group and heterogeneous echo group were significantly higher than the equal-echo group (al P 0. 05). The intraplaque enhanced intensities in the low-echo group, equal-echo group, and heterogeneous echo group were 22. 62 ± 9. 33 dB, 14. 38 ± 8. 02 dB, and 18. 15 ± 9. 64 dB, respectively (F = 3. 877, P = 0. 027). The low-echo group was significantly higher than the equal-echo group (P = 0. 024 ). Multivariate logistic regression analysis showed that carotid intraplaque neovascularization (odds ratio 3. 456, 95% confidence interval 1. 103 - 10. 828; P = 0. 033) was independently associated with acute ischemic cerebrovascular disease. Conclusions Carotid intraplaque neovascularization is closely associated with acute ischemic cerebrovascular disease.
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In resent years,brain parenchyma and cerebrovascular sonography have received considerable attention.Monitoring of cerebral vessels and their blood flow velocities and pulsation indexes may reflect the intracranial vascular lesions.However,there are a few studies about transcranial color-code duplex sonography (TCCD) in the monitoring of space-occupying stroke.This technology has the non-invasive,convenient,and economical advantages,and can timely provide clinical information.Using TCCD to monitor pace-occupying stroke may play a positive role in prevention of the diseases and prognosis.
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Objective To study the clinical significance of diffusion weighted imaging (DWI) positive lesions in transient ischemic attacks (TIA) patients,TIA patients with fully reversible lesions were compared with the other patients for investigating the predictive value of apparent diffusion coefficient(ADC) for distinguishing between TIA and stroke.Methods Fifty-seven patients hospitalized with TIA at Department of Neurology,Central Hospital of Baotou August 2009 to June 2011 were identified.All patients had brain magnetic resonance imaging within 24 h after onset,then they were divided into DWI positive group and negative group.A follow-up MR imaging or CT was available in patients of DWI positive group.According to MRI or CT,patients were divided into TIA group and cerebral infarction (CI) group.Clinical features and DWI Imaging were compared between the two groups.For each lesion,the quantitative parameters on initial DWI (ADC) were recorded,and comparisons between reversible and irreversible lesions were performed.Results The ADC values were (630.4 ±25.9) × 10-3 mm2/s in lesions with TIA and (495.2 ±60.0) x 10-3 mm2/s with brain infaction (t =6.669,P =0.000).The relative ADC ratio values were lower (62.6％ ±7.4％ vs 82.1％ ±5.6％,t =7.013,P =0.000) in lesions with subsequent infarct than in those that were fully reversible.Conclusions ADC values are moderately decreased in DWI lesions from TIA patients,while ADC values are significantly decreased in CI group.It is useful to early distinguish TIA from CI by comparing ADC and rADC values.