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Objective: To detect the serum levels of D-dimer and N-terminal pro B-type natriuretic peptide [NT-pro BNP] in patients with Acute Ischemic Stroke [AIS], and to explore the risk factors of AIS
Methods: A total of 246 AIS patients treated in our hospital from January 2015 to January 2017 were selected. Meanwhile, 240 healthy subjects were selected as a control group. The D-dimer and NT-pro BNP levels of the two groups were compared. Correlations of such levels with age, gender, blood lipid, Intima- Media Thickness [IMT], fibrinogen and degree of neurological deficits were analyzed
Results: The AIS group had significantly higher levels of Triglyceride [TG], Low-Density Lipoprotein [LDL], D-dimer, NT-pro BNP and fibrinogen as well as IMT than those of the control group, but the High-Density Lipoprotein [HDL] level of the AIS group was significantly lower [P<0.05]. The patients with different genders and ages had significantly different D-dimer and NT-pro BNP levels [P<0.05]. The D-dimer and NT-pro BNP levels were correlated with gender and age. Such levels of females were significantly higher than those of males [P<0.05]. The D-dimer and NT-pro BNP levels of the >/= 60 years old group significantly exceeded those of the <60 years old group [P<0.05]. The levels of D-dimer and NT-pro BNP were negatively correlated with that of HDL [P<0.05], but positively correlated with TG, LDL and fibrinogen levels, IMT, and National Institutes of Health Stroke Scale score [P<0.05]. Multivariate Logistic regression analysis showed that the OR values of D-dimer and NT-pro BNP were 3.65 and 6.96 respectively
Conclusion: Serum D-dimer and NT-pro BNP levels usually increased in AIS patients, and the levels were significantly correlated with AIS onset
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Objective To investigate the positive rate of microembolic signal (MES) and the related factors,as well as the correlation between MES and outcomes in patients with cardiogenic cerebral embolism.Methods Patients with cardiogenic cerebral embolism were enrolled.The baseline data of the patients were collected and the MES monitor was conducted.The baseline data of the MES positive group and MES negative group were compared.Multivariatelogistic regression analysis was used to identify the related factors of the positive MES.The patients were followed up regularly.The outcomes of stroke at 6 months and recurrent stroke within 2 years in the MES positive group and MES negative group were compared.Results A total of 165 patients with cardiogenic cerebral embolism were enrolled,including positive MES in 68 patients (41.2％).There were significant difference in the levels of brain natriuretic peptide (BNP),cardiac troponin-I (cTn-I),and D-dimer between the MES positive group and negative group.Multivariate logistic regression analysis showed that the increased levels of baseline BNP (odds ratio [OR] 1.001,95％ confidence interval CI 1.001-1.002;P＜0.001),cTn-I (OR 36.975,95％ CI 1.516-902.0;P=0.027),and D-dimer (OR 1.001,95％ CI 1.000-1.001;P=0.017) were independently associated with the positive MES in cerebral embolism within 48 h after onset.There was no significant difference in the proportion of patients in good outcome (modified Rankin scale score 0-2) and poor outcome (modified Rankin scale score ＞2) after 6 months between the MES positive group and MES negative group.When the average follow-up time was 20.8 months (range,7-24 months),there were 23 patients (33.8％) and 19 (19.6％) had recurrence in the MES positive group and MES negative group,respectively.Kaplan-Meier analysis showed that the recurrence rate of stroke in the MES positive group was significantly higher than that in the MES negative group (log-rank test:P=0.031).COX regression analysis showed that the positive MES was still an independent risk factor for stroke recurrence after adjusting for other confounding factors (OR 0.328,95％ CI 0.142-0.761;P=0.009).Conclusions The positive MES was associated with the increased BNP,cTn-I,and D-dimer levds.The positive MES was not associated with clinical outcomes at 6 month after the onset,but it was associated with the recurrence of stroke within 2 years.
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Objective To evaluate the detection of membrane neutrophil alkaline phosphatase (NAP)in diagnosis of infection in patients with acute cerebral hemorrhage.Methods A total of 208 patients with acute cerebral hemorrhage,including 1 52 cases without infection (uninfected group)and 56 cases with infection (infected group),admitted in the Second Affiliated Hospital of Nantong University during January 201 0 to July 201 6 were enrolled,30 healthy subjects were also enrolled in the study as control group.The peripheral blood from all subjects were collected,and the counts of white blood cell (WBC), percentage of neutrophil,serum procalcitonin (PCT)and NAP were measured.The value of above 4 indicators in diagnosing infection was determined by receiver operating characteristic (ROC ) curves. ANOVA and t test were used to analyze the data,Pearson correlation was performed to analyze the correlation between NAP and PCT in infected group.Results The levels of WBC,percentage of neutrophil and NAP in both infected and uninfected group were higher than those in healthy control group at admission(F =1 1 7.64, 1 00.69 and 425.09,all P <0.01 ),and the levels of WBC,PCT and NAP were also higher when infection occurred compared with those at admission in infected group (t =3.1 4,34.30 and 36.39,all P <0.01 ). The expression of NAP was positively correlated with PCT in infected group (r =0.762,P <0.05).ROC curve analysis showed that the areas under the curves of NAP and PCT in diagnosis of infection were 0.875 and 0.884,respectively.When 1 0655.28 AB/c and 5.01 mg/L were taken as cut-off values,the sensitivities of NAP and PCT in diagnosis of infection were 85.50% and 87.66%;the specificities were 90.50%和 90.31 %,respectively.The level of NAP in infected patients with gram-positive bacterial infections was higher than that in patients with gram-negative bacterial infections (t =6.29,P <0.01 ). Conclusion The expression of NAP in patients with acute cerebral hemorrhage increases when infection occurs,which may be helpful to the clinical diagnosis of bacterial infection.
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Objective To investigate the effect of intermittent use of low molecular heparin (LMWH) on microembofic signal (MES) in patients with ischemic stroke on the basis of anti-platelet aggregation and statin therapy.Methods Ninety MES-positive patients with acute ischemic stroke detected by transcranial Doppler were randomly divided into a non-LMWH group (n =44) and a LMWH group (n =46).The non-LMWH group was treated conventionally with enteric-coated aspirin and atorvastatin.On the basis of conventional therapy,the LMWH group was treated with LMWH,subcutaneous injection of LMWH calcium 4 100 AXaIU every 3 months,twice a day,and one week as a course of treatment (a total of 3 courses).The number of MES,MES-positive rate and incidence of ischemic cerebrovascular events at 3 and 6 month were compared in both groups.Results There was no significant difference in the MES-positive rates at 3 month after treatment between the non-LMWH group and the LMWH group (70.45％ vs.61.36％ ;x2 =1.357,P =0.244),but the number of MES in the non-LMWH group was higher than that in the LMWH group (12.07 ± 10.16 vs.8.09± 8.13; t =1.470,P =0.043); the MES-positive rate at 6 month after treatment in the non-LMWH group was significantly higher than that in the LMWH group (36.96％ vs.19.57％;x2=3.982,P=0.046),and the number of MES in the non-LMWH group was also significantly higher than that in the LMWH group (10.32 ±9.93 vs. 1.46 ± 3.27; t =5.450,P =0.000).There was no significant difference in incidence of ischemic cerebrovascular events at 3 month (2.17％vs. 9.09％,P =0.198 ),but the incidence of ischemic cerebrovascular events at 6 month in the LMWH group was significantly lower than that in the non-LMWH group (4.35％ vs.20.45％,P =0.025).Conclusions On the basis of anti-platelet aggregation and statin therapy,the intermittent use of LMWH may decrease the MES-positive rate and the incidence of ischemic cerebrovascular events in the MES-positive patients with ischemic stroke at 6 month.
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Objective To investigate the relationship between mean amplitude of glycemic excursions (MAGE) and cognitive impairment in elderly patients with type 2 diabetes.Methods Totally 80 patients (aged ＞ 60 years) with type 2 diabetic were selected.According to the Montreal Cognitive Assessment (MoCA) score,the patients were divided into two groups:cognitive impairment group (31cases) and non-cognitive impairment group (49 cases).Then all subjects were observed by continuous glucose monitoring for 3 days including the mean blood glucose (MBG) and its standard deviation (SD),MAGE and numbers of glycemic excursion (NGE).Results Compared with noncognitive impairment group,diabetic course,fasting blood glucose,2 h postprandial glycemia,glycosylated hemoglobin (HbA1c) and body mass index (BMI) were significantly different with the cognitive impairment group (P＜0.05).Furthermore,MAGE,MBG and SD were obviously higher than those in the non-cognitive impairment group [(5.89 ± 2.17) mmol/L vs.(3.15 ± 0.60) mmol/L,t＝8.37,P＝0.00; (11.85±3.45) mmol/L vs.(8.23±1.73)mmol/L,t＝6.23,P＝0.00; (3.16±1.29)mmol/L vs.(1.26±0.42)mmol/L,t＝9.57,P＝0.00].MoCA scores of patients with type 2 diabetes were negatively correlated with MAGE (r ＝-0.891,P ＜ 0.01).After multiple linear regression analysis,diabetic course,2 h postprandial glycemia,MAGE and SD remained independently associated with cognitive impairment in type 2 diabetic patients (R2 ＝0.835,P＜0.05)Conclusions MAGE during a daily period is associated with cognitive impairment independent of fasting blood glucose,postprandial glycemia and HbA1c.
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Objective To research the pathogeny and the electromyographic characteristics of myokymia.Methods The clinical features and electromyography of 42 elderly patients with myokymia were examined. Results Symptomatic myokymia (SM) in 27 cases was caused by low salt syndrome, thyrotoxemia, urinaemia, chronic wasting diseases (such as carcinoma of the stomach or liver), brachial plexus neuropathy, lead poisoning, chronic inflammatory demyelinating polyradiculoneuritis, succinylcholine narcosis, restless leg syndrome or Isaac's syndrome.Symptomatic facial myokymia was caused by neoplasm of the brain stem or in posterior cranial fossa, multiple sclerosis or other causes. Primary myokymia ( PM ) in 15 cases involved idiopathic generalized and benign myokymia.Compared with PM, SM was more constant and powerful. Myokymia potential appeared in the electromyograms of 42 of the patients. The majority of patients with SM had accompanying myotonic discharge. Conclusion The pathogeny and electromyographic characteristics of symptomatic myokymia are different from the primary stage.
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@#Objective To study the effects of hyperbaric oxygen （HBO） therapy in patients with acute intracerebral hemorrhage on serum adhesion molecules. Methods 66 cases with acute intracerebral hemorrhage were divided into routine treatment group (n=33) and HBO treatment group (n=33). 30 health persons were selected as normal trontrol. The level of adhesion molecules, including intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin, were measured before and after treatment. Results The levels of adhesion molecules in routine and HBO treatment groups were higher than those in normal control group when hospitalized (P<0.01). All the adhesion molecules levels in two treatment group were decreased after the treatment, and more significantly in HBO group (P<0.05). Conclusion HBO therapy may ameliorate the adhesion molecule abnormalities after intracerebral hemorrhage.
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Objective To study the effect of hyperbaric oxygen (HBO) therapy on perihematomal edema in acute spontaneous intracerebral hemorrhage. Methods Sixty-three consecutive hospitalized patients with supraten-torial intracerebral hemorrhage were allocated to an HBO group (n = 30) or a control group (n = 33) at random. Routine therapies were used with both groups. The treatment group received in addition twenty consecutive daily ses-sions of HBO therapy beginning 3～5 d after onset. MRI brain scans were performed on the 5～7th and 25th day. Absolute edema volumes and relative edema volumes were measured from T2-weighted images. Apparent diffusion co-efficients (ADCs) of the edematous regions were calculated on diffusion-weighted images (DWI). Results There were no statistical differences between the two groups in terms of age, sex, blood pressure, NIHSS, hematoma posi-tion or volume. At the 5th～7th d, both absolute and relative edema volumes in the HBO group were smaller than in the controls (P≤0.05). Brain edema was still prominent at the 25th d. Absolute edema volumes, relative edema volumes and ADC values were all smaller in the HBO group at the 25th day compared with the controls (P≤0.05). Conclusion HBO therapy soon after intracerebral hemorrhage can lessen the severity and range of brain edema. E-dema persists after the onset of the disease, and HBO can reduce such delayed brain edema. HBO may benefit func-tional recovery from intracerebral hemorrhage by reducing perihematomal edema.